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1
Morgan, Jonathan J. "State Regulation of Assisted Reproductive Technology." BYU ScholarsArchive, 2010. https://scholarsarchive.byu.edu/etd/2206.
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State regulation of assisted reproductive technology (ART) has been occurring since the inception of earlier technological advances such as artificial insemination to aid human reproduction. I provide a brief overview of the current regulation of ART in the U.S. and the literature on state regulation. Unlike previous studies of ART regulation which use content analysis or case studies of individual state laws I estimate ART regulation for the entire U.S. by using a series of random effects logistic regression models for the time period 1995-2006. To my knowledge this is the first quantitative analysis of ART regulation. I test the hypothesis that the demand for ART is an important predictor of ART legislation in the U.S. Other hypotheses derived from the ART literature were also tested in the analysis. Results indicate that demand for ART is the most influential factor in predicting ART legislation from 1995-2006. Additionally, educational attainment of a state's population and the percentage of married couple households with children in each state may have a direct effect on the demand for ART and an indirect effect on ART regulation.
2
Batty, Lynne Patricia. "Assisted Reproductive Technology: The Aotearoa/New Zealand Policy Context: A thesis submitted in fulfilment of the requirements for the degree of Master of Arts in Sociology in the University of Canterbury." Thesis, University of Canterbury. Sociology, 2002. http://hdl.handle.net/10092/912.
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The focus of this thesis is the current policy situation in relation to assisted reproductive technologies (ART) in Aotearoa/New Zealand. I explore how government policies (and lack of policy) have shaped access to ART. I also explore the policy initiatives of funding agencies, the National Ethics Committee on Assisted Human Reproduction (NECAHR), managers, healthcare professionals, and interest groups. My investigation into ART policy issues critically examines the various formal mechanisms and policies used to regulate and control ART in Aotearoa/New Zealand. Drawing on my analysis of policy-focused documents and material from in-depth interviews with key actors in the policy debate, I demonstrate how the ad hoc and contingent approach to ART developments, practices, funding, and access has contributed to inconsistent and inequitable access to ART services. I argue that the lack of an ART-specific policy organisation contributes to fragmented, and possibly discriminatory, policy decisions. I examine how the use of restrictive access criteria to manage the increasing demand for publicly funded ART services disadvantages certain groups wishing to use these services. By investigating the influence of rationing strategies on the allocation of resources and regulation of access, I provide some appreciation of the 'messy reality' of policy creation, interpretation, and implementation. I argue that the criteria used to limit access to public ART services obscure the use of social judgements and provider discretion. Likewise, they succeed in limiting publicly funded ART treatments to those who conform most effectively to the normative definition of family. My analysis of the ART policy discourse identifies silences and gaps in relation to specific ART practices, particularly the use of ART by Maori. I highlight the invisibility and marginalisation of Maori within the ART policy debate. After examining the broader issues concerning Maori access to health services, I explore how these may affect Maori using ART services to overcome infertility. I argue that the gathering of information about the utilisation of ART services is crucial for the accurate identification of the needs of Maori. It is also fundamental for effective monitoring of state health policy decisions and outcomes.
3
Hamdan, Mukhri. "Endometriosis and assisted reproduction technology." Thesis, University of Southampton, 2016. https://eprints.soton.ac.uk/416621/.
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Endometriosis is a disease that is historically known to present in many guises. Since 13th century it has been metaphorically regarded as an animalistic womb causing female hysteria. Albeit widely researched, significant controversies that surround the disease remain unsolved, from the clinical presentations, diagnosis, right through to its management strategies. Despite the rapid advancement of technology in modern medicine, the ideal diagnostic and investigative tool of the disease remains elusive, and hence the management of the disease remains a challenge to clinicians. Whilst it is long known that endometriosis is detrimental to fertility, it is unclear if Assisted Reproductive Technology (ART) obliterates that risk. This thesis aims to investigate the impact of different stages and types of endometriosis on ART outcomes, and how various surgical interventions influence the reproductive outcomes. The thesis will also focus on answering two important questions in endometriosis research, that of whether and how endometriosis impacts on 1) the developing oocytes and embryo, and 2) the endometrium. The thesis begins with the introduction of two robust systematic reviews and meta-analyses, which concluded that women with endometriosis had a lower pregnancy rate and fewer oocytes retrieved during ART. Worse reproductive outcomes were found in those with more severe disease. Surgical treatment, which traditionally is thought to be beneficial, was found to result similar reproductive outcome in diseased and controls, and possibly more harm. Gathering evidence retrospectively from the IVF databases supported the former conclusion that women with endometriosis undertaking ART had lower number of oocytes collected from matured follicles, and further investigation into the laboratory details showed that women with endometriosis had a higher proportion of early embryo arrest. A mouse oocyte model was then utilised to explore the influence of follicular fluid of women with endometriosis on oocyte development. The study found that follicular fluid retrieved from women with endometriosis results in the activation of DNA damage response pathway, which in turn prevented normal oocyte maturation. These effects were found reversed by the agent resveratrol. The thesis concludes with a biomarker discovery study on the endometrium of women with endometriosis compared to controls using a highly sensitive and specific state of the art proteomics analysis method (liquid chromatography mass spectrometry with isobaric tag for relative and absolute quantitation (LCMS/MS iTRAQ®) which uncovered unique proteins not yet described in the literature. Endometriosis is a disease that is detrimental to the reproductive outcomes of those undergoing ART. Its influence on reproduction is complex, but it is now clear that its impact on reproduction does not stop at the traditionally viewed anatomical distortion with resultant subfertility; but have far reaching consequences including that of defective oocyte and embryo development, with a differential impact on the endometrial proteome. The solution to this challenging disease partly lies in the early diagnosis and treatment of the condition; as such not withstanding pitfalls and fallacies surrounding biomarker discovery research, the ultimate validation of a diagnostic panel of biomarkers for the non-invasive diagnosis of endometriosis is now urgently needed.
4
Wilson, Poe Emma. "Vitrification of day 5/6 human morulas/blastocysts: A 10 year retrospective study in a private assisted reproductive techniques [ART] clinic." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/96876.
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Thesis (MMed)--Stellenbosch University, 2015.<br>ENGLISH ABSTRACT: This study was designed to retrospectively evaluate the established embryo vitrification/warming programme currently implemented at Drs Aevitas Institute for Reproductive Medicine and to look at factors that might play a role in optimizing the pregnancy outcomes thereof.
Vitrification is the achievement of a “state of suspended animation” wherein molecular translational motions are arrested without structural reorganization of the liquid. In embryo vitrification it involves placement of the embryo in a very small volume of vitrification medium that must be cooled at extremely high cooling rates. The vitrification medium contains cryoprotectants to prevent any cryoinjury from occurring to the embryo.
This process was initially proposed to effectively manage supernumerary embryos, but it has also provided a viable method of reducing costs for additional embryo transfers as well as the reduction of the incidence of multiple births. Patients who are at risk of ovarian hyper stimulation syndrome (OHSS) can also have all of their embryos vitrified in advance to reduce the likelihood of adverse clinical symptoms if a pregnancy is established.
Throughout the period in which vitrification has been in practice, there have been advances in technology as well as continual research being conducted to establish whether newly suggested techniques do, in fact, optimize the outcomes of vitrification. Focus has subsequently been applied to the carrier device used for vitrification, the day on which the embryos are vitrified and stored, as well as the number of embryos transferred in each respective cycle, all to ensure the most favourable outcome.
This retrospective study confirmed the use of the Cryotop® as the most viable carrier device for successful survival and pregnancy outcomes. Transfer of day 5 vitrified embryos resulted in significantly higher pregnancy rates compared to day 6 vitrified embryos. Results also indicated that the number of embryos transferred does indeed have a significant effect on the pregnancy outcome and consequently we can possibly argue against the implementation of single embryo transfer in the vitrification programme. Investigation into the effect of female age, specifically oocyte age, on each of these categories indicated that reduced age can be associated with optimal outcomes; however this could not be proven statistically in this cohort of patients.
To further look at optimization of the vitrification/warming programme, a Literature Survey was conducted to ascertain the results after Assisted Hatching in frozen/warmed human embryos. Assisted Hatching has been proposed as a solution to Zona Pellucida hardening, which has been found to occur during vitrification. The need for further studies and a meta-analysis of the literature is confidently proposed, as well as a Prospective Study to evaluate the effect of Laser Assisted Hatching in the human blastocyst vitrification/warming programme at Drs Aevitas Institute for Reproductive Medicine.<br>AFRIKAANSE OPSOMMING: Hierdie studie is ontwerp om die gevestigde embrio vitrifikasie/ontdooi program by Drs Aevitas Instituut vir Reproduktiewe Medisyne, retrospektief te evalueer en die faktore te optimaliseer wat swangerskap uitkomste kan beïnvloed. Vitrifikasie is die proses waardeur die molekulere aktiwiteit binne die embrio in ‘n staat van arres gehou word sonder om die strukture binne die sitplasma te versteur. Dit behels die plasing van ʼn embrio in 'n klein hoeveelheid vitrifikasie medium wat teen 'n hoë tempo afgekoel word. Die vitrifikasie medium bevat kriobeskermmiddels wat die embrio tydens die vitrifikasie proses teen moontlike skade beskerm.
Hierdie proses is aanvanklik voorgestel om oortollige embrio’s doeltreffend te bestuur. Dit bied ʼn koste effektiewe metode vir embrio terugplasing, en verlaag die insidensie van veelvoudige swangerskap. Vitrifikasie bied pasiënte met ʼn hoë risiko vir ovariale hiperstimulasiesindroom (OHSS) ‘n alternatief om nadelige kliniese simptome te vermy indien ʼn swangerskap bereik word.
Tegnologiese vordering en voortdurende navorsing ondersoek voortdurend nuwe tegnieke vitrifikasie uitkomste te optimaliseer. Fokus word geplaas op die draertoestel wat gebruik word vir vitrifikasie, die dag waarop die embrio's gevitrifiseer en gestoor word, sowel as die aantal embrio’s wat met elke vitrifikasie siklus teruggeplaas word.
Hierdie retrospektiewe studie het bevestig dat die gebruik van die Cryotop® die mees suksesvolle toestel vir oorlewing en swangerskap uitkomste is. Die terugplasing van dag 5 gevitrifiseerde embrios het beduidende hoër swangerskapsyfers as dag 6 embrios tot gevolg gehad. Die resultate het ook aangedui dat die aantal embrio's wat teruggeplaas word 'n beduidende uitwerking op die swangerskapsyfer het. Daar kan dus moontlik teen die implementering van 'n enkel embrio-terugplasing neiging in die vitrifikasie program geargumenteer word. Resultate het ook getoon dat optimale uitkomste verwant is aan ʼn laer oösiet ouderdom, alhoewel dit nie in die groep pasiente statisties bewys kon word nie.
'n Literatuurstudie oor AH (Assisted Hatching) op gevitrifiseerde/ontdooide menslike embrio’s is uitgevoer om die vitrifikasie/ontdooi program verder te optimaliseer. AH bied ‘n oplossing vir Zona pellucida verharding, wat tydens vitrifikasie plaasvind. Verdere studies, 'n meta-analise van die literatuur, sowel as 'n prospektiewe studie om die effek van laser AH in gevitrifiseerde/ontdooide menslike blastosiste by Drs Aevitas Instituut vir reproduktiewe medisyne te evalueer, word voorgestel.
5
Mayeur, Anne. "La prévention des maladies mitochondriales par mutation de l'ADNmt : de la clinique au transfert de pronoyaux." Electronic Thesis or Diss., université Paris-Saclay, 2024. http://www.theses.fr/2024UPASL084.
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Les mitochondries ont la particularité de posséder leur propre génome, l'ADN mitochondrial (ADNmt), transmis exclusivement par la mère via le cytoplasme de l'ovocyte. Les mutations pathogènes au sein de l'ADNmt sont à l'origine des maladies mitochondriales. Le transfert de pronoyaux (TPN), non autorisé en France, est une technique proposée depuis 2016 par le Royaume Uni afin de substituer le génome mitochondrial muté d'un zygote par un autre non muté. Cette méthode reste largement débattue sur le plan international en termes d'efficacité et de sécurité. L'objectif de nos travaux était d'évaluer la faisabilité clinique et technique du TPN. Nos recherches ont confirmé que les femmes porteuses d'un variant pathogène de l'ADNmt présentaient des critères de réponse ovarienne à la stimulation comparable à un groupe contrôle. Grâce à une étude sociologique nous avons également montré que cette technique recevait une adhésion par la grande majorité des femmes interrogées principalement car elle permet de maintenir un lien génétique entre une femme et son enfant. Puis nous avons mis au point la technique de TPN en utilisant des zygotes triploïdes (3PN) donnés à la recherche et après autorisation de l'Agence de Biomédecine. Enfin, nous avons évalué la pertinence de l'utilisation des 3PN et démontré leurs limites en termes de développement et de statut chromosomique, même lorsque la diploïdie était rétablie. Ces travaux ouvrent des perspectives sur la faisabilité et l'acceptation du TPN. De futures recherches sont nécessaires pour explorer la sécurité de cette technique<br>Mitochondria have the unique characteristic of possessing their own genome, mitochondrial DNA (mtDNA), which is exclusively transmitted by the mother through the cytoplasm of the oocyte. Pathogenic mutations in mtDNA are responsible for mitochondrial diseases. Pronuclear transfer (PNT), not authorized in France, is a technique proposed by the United Kingdom since 2016 to replace the mutated mitochondrial genome of a zygote with a non-mutated one. This method remains widely debated internationally regarding its efficacy and safety. The aim of our work was to evaluate the clinical and and technical feasibility of PNT. Our research confirmed that women carrying a pathogenic variant of mtDNA exhibited ovarian response criteria to stimulation comparable to a control group. Through a sociological study, we also showed that this technique received support from the majority of women surveyed, primarily because it maintains a genetic link between a woman and her child. Subsequently, we developed the PNT technique using triploid zygotes (3PN) donated for research, following authorization from the Biomedicine Agency. Finally, we assessed the relevance of using 3PN and demonstrated their limitations in terms of development and chromosomal status, even when diploidy was restored. This work opens up perspectives on the feasibility and acceptance of PNT. Future research is necessary to explore the safety of this technique
6
Pangestu, Mulyoto 1963. "Drying biological material for use in assisted reproductive technology." Monash University, Institute of Reproduction and Development, 2002. http://arrow.monash.edu.au/hdl/1959.1/7879.
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Chang, Jeani. "Relationship Between Assisted Reproductive Technology and Risk of Stillbirth." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4508.
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Assisted reproductive technology (ART) is an infertility treatment used to assist women to become pregnant. Although the procedure is safe, there are gaps in understanding the association between treatment and adverse pregnancy outcomes (e.g., stillbirth) in the United States. The purpose of this study was to investigate the relationship between stillbirth delivery and ART. The 2 research questions addressed the association between methods of conception (ART versus non-ART) and the delivery of a stillbirth, and the association between multiple gestation pregnancy and risk of stillbirths. Retrospective cohort data from the States Monitoring ART collaborative were analyzed using Pearson's chi squared tests and log binominal regression models. Findings indicated that from 2006 to 2011, the average stillbirth rates were lower among ART-conceived pregnancies than non-ART conceived pregnancies. After controlling for confounding factors, ART-conceived pregnancies did not show increased risks of stillbirths compared to non-ART conceived pregnancies regardless of plurality. This lower risk of stillbirth was particularly significant during early pregnancies, before 28 weeks of gestation. Findings may be used to improve understanding of the use of ART treatment and its associated pregnancy outcomes. Findings may also be used to prevent stillbirths and to improve prenatal care, early stillbirth detection, and effective clinical management of fetal and maternal conditions during pregnancy.
8
Sengupta, Anindita. "The Desired Baby: Assisted Reproductive Technology, Secrecy, and a Cultural Account of Family Building in India." The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1483451149153858.
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9
McComiskey, Mark Henry. "Unrecognised healthcare consequences of children born following assisted reproductive technology." Thesis, Queen's University Belfast, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.675460.
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The consensus is that children born following ART are delivered earlier and at a lower birthweight that those naturally conceived and have a higher likelihood of requiring admission to a neonatal intensive care unit (NICU). The longer term prospects for artificially conceived children seem comparable to the naturally conceived population for the majority of medical conditions. This study examined NICU admission registry data of children born 111/2001 to 31/12/2007. Odds ratios (OR) for NICU admission were produced. All paediatric hospital admissions in Northern Ireland 1/7/1996 through 3016/2009 were also studied. Standardised admission ratios (SAR's) for children up to 13 years old born following ART were calculated. Unadjusted OR for NICU admission was 0.92 (95% CI 0.71, 1.18) for singleton~ and 0.83 (95% CI 0.69, 0.99) for twins. Adjustment for hospital, gestation and year showed OR for NICU admission to be 0.68 (95% CI 0.49, 0.93) for singletons and 0.76 (95% CI 0.60, 0.97) for twins. SAR for all- and first hospital admissions in ART children were 80 (95% CI 76, 84) and 74 (95% CI 68, 80) respectively. Children born fOllowing IVF had increased all-hospital SAR compared to those born following ICSI (SAR 85, 95% CI 80, 90 vs. SAR 71,95% C164, 77; p=0.001). Those born following fresh embryo had increased all-hospital SAR compared to those born fallowing frozen embryo transfer. All-admission analysis showed Significant increases in SAR with diagnoses of cerebral palsy and inguinal hernia. Non-significant trend for increased SAR for all-hospital admission and first-hospital admission was found for some diagnoses. This study adds some reassurance to the neonatal and long-term child health of those born following ART. IVF children and those born following fresh embryo transfer may not be as healthy throughout childhood as their ICSI and frozen embryo transfer peers. Published concerns regarding neurological conditions and congenital abnormalities in children conceived using ART are supported by this study.
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Hui, Pui-wah. "Nuchal translucency in pregnancies conceived after assisted reproduction technology." Click to view the E-thesis via HKUTO, 2003. http://sunzi.lib.hku.hk/hkuto/record/B31971040.
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Hui, Pui-wah, and 許佩華. "Nuchal translucency in pregnancies conceived after assisted reproduction technology." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B31971040.
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Ellender, Stacey. "Assisted reproduction defining and evaluating the multiple outcomes of technologically advanced interventions /." online access from Digital Dissertation Consortium, 2005. http://libweb.cityu.edu.hk/cgi-bin/er/db/ddcdiss.pl?3193097.
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Smith, Heather K. "The impact of framing on policy passage: the case of assisted reproductive technology." Thesis, Georgia Institute of Technology, 2011. http://hdl.handle.net/1853/42774.
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In the last 30 years, in vitro fertilization (IVF) has created a significant amount of controversy around the world. Within the U.S., policy movement has been limited, occurring primarily at the state level, which has created a fragmented system of rules to manage the technology. However, there appear to be indications that how the issue is presented, and which actors are chosen to be represented in legislation, may impact the passage of policy, thereby also providing a reason for why little policy movement has occurred. In this study, pieces of federal, California and Georgia legislation were examined for the occurrence of differing frames, as identified by the actors presented, in order to determine whether different frames occurred in passed legislation than those found in failed legislation. It was determined that, while actors did not differ significantly between passed and failed legislation, there were some slight differences between actors used at the federal level, as well between the different state levels. Even further, the presentation of actors and their interests did appear to differ slightly between passed and failed legislation.
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Goldsmith, Shona. "Population studies of assisted reproductive technology and congenital anomalies in cerebral palsy." Thesis, The University of Sydney, 2019. https://hdl.handle.net/2123/21909.
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BACKGROUND: Risk factors for cerebral palsy (CP) have been identified across the conception, pregnancy, perinatal and postneonatal periods, including Assisted Reproductive Technology (ART) and congenital anomalies. ART likely increases risk of CP through mediating factors including multiple and preterm birth, but this requires further investigation in Australia. While congenital anomalies are an identified risk factor for CP, their reported prevalence varies widely. This thesis describes the epidemiology of CP with respect to these two independent factors. METHODS: A series of population-based studies were conducted. The influence of ART on prevalence of CP and clinical outcomes in Western Australia was explored in a population-based data-linkage study. Population-based research describing congenital anomalies in CP was synthesised in a systematic literature review. The most common congenital anomaly in CP from the review, congenital microcephaly, was investigated in a Western Australian population case-control study. Finally, population data-linkages were conducted in Australia and Europe to examine major congenital anomalies and outcomes in children with pre/perinatally acquired CP and postneonatally acquired CP (PNN-CP). RESULTS: ART was associated with a two-fold increased risk of CP. While multiple and preterm births were common after ART, additional risk of CP existed for very preterm ART singletons. The systematic review identified congenital anomalies in 12–32% of children with pre/perinatal CP and 20% of PNN-CP. Children with CP had a three-fold risk of congenital microcephaly in the case-control study. In Australia and Europe, congenital anomalies were identified in approximately one in four children with CP. Isolated cerebral anomalies were most common in children with pre/perinatally acquired CP, and isolated cardiac anomalies in PNN-CP. Congenital anomalies were associated with more severe outcomes for children with pre/perinatally acquired CP, but not PNN-CP. CONCLUSION: ART and congenital anomalies are important factors in the epidemiology of CP, and opportunities for prevention may lie in these pathways to CP. Research is planned to: a) evaluate temporal trends in ART and CP in Australia and b) further elucidate pathways and risk of CP for children with specific anomalies.
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Hoogendijk, Christiaan F. (Christiaan Frederik). "Sperm DNA fragmentation : implications in assisted reproductive technologies." Thesis, Stellenbosch : Stellenbosch University, 2007. http://hdl.handle.net/10019.1/21626.
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Dissertation (PhD)--University of Stellenbosch, 2007.<br>ENGLISH ABSTRACT: Male fertility has for many years been defined in vitro as the ability of sperm to fertilize
oocytes and to obtain early cleavage-stage embryos. Spermatozoa comprise of an
extraordinary high percentage of polyunsaturated fatty acids in their plasma membrane.
Due to an extremely low content of cytoplasm, sperm cells have a particularly low
potential to scavenge reactive oxygen species (ROS), and are therefore highly sensitive
to oxidative processes, which lead to sperm nucleus DNA damage/fragmentation.
Normally, DNA fragmentation occurs in every ejaculate and can be induced by an
excessive ROS production of active leukocytes or the spermatozoa themselves. Under
distressed conditions, DNA fragmentation may also occur in the testis as a result of
oxidative processes in the apoptotic cascade. These DNA fragmentations can be
regarded as late signs of programmed cell death (apoptosis).
Clinically, DNA fragmentation in spermatozoa results in significantly decreased
implantation and pregnancy rates especially in patients with oligo- and/or
teratozoospermia. The p-pattern normal sperm morphology has been shown to give
poorer fertilization rates in vitro than the g- and n-patterns. In this study there is
reported on the significant correlation found between the p-pattern normal sperm
morphology and sperm DNA fragmentation as measured with the terminal
deoxynucleotidyl transferase-mediated dUDP-biotin end labeling (TUNEL) assay. This
finding further explains the lower fertility potential of patients presenting with p-pattern
normal sperm morphology.
In addition, this study explores the intricate relations between ROS in the semen, DNA
fragmentation of the spermatozoa, as measured with the TUNEL assay and the sperm
chromatin structure assay (SCSA ), spermatozoa apoptotic status and sperm
parameters as measured with a standard semen analysis. Positive correlations were
found between ROS and the apoptotic status of the sperm, as well as between sperm
with non-fragmented DNA and sperm concentration and percentage motility. The
results emphasize the importance of sperm selection especially when the treatment of
choice is intracytoplasmic sperm injection (ICSI). An early sign of programmed cell death, also known as apoptosis, is the externalization
of phosphatidylserine (PS) from the inner membrane leaflet to the outer leaflet. PS
shows a high affinity to Annexin V. Apoptotic spermatozoa are able to fertilize oocytes,
but embryo senescence may occur at the time when the paternal genes are activated.
In this study there is reported on a novel method whereby spermatozoa can be
separated on the basis of their apoptotic status through flow cytometry. Results showed
that the normal sperm morphology, according to strict criteria, of the resultant nonapoptotic
sperm fraction is significantly higher than that of the apoptotic counterpart.
With refinement of this technique, it will be possible in future to use these separated
non-apoptotic sperm cells during ICSI for fertilization.
From the above it is apparent that the spermatozoon has to play a vital role in the
development of the embryo from fertilization to implantation and pregnancy. It is,
however, important to note that besides the gametes, there are other critical factors
which contribute to a successful in vitro fertilization (IVF) cycle, among these are the in
vitro culture conditions. In this regard, this study compared two sequential embryo
culture systems. It was found that the more complex medium resulted in better day
three embryo quality and a better blastocyst formation rate and pregnancy rate.
These findings highlight the importance of a holistic perspective towards the complexity
of the factors involved in affecting embryo quality and pregnancy outcome.<br>AFRIKAANSE OPSOMMING: Manlike fertiliteit is vir baie jare gedefinieer as die in vitro vermoë van ‘n spermsel om ‘n
eiersel te bevrug om sodoende embrios te verkry. Die spermsel se plasmamembraan
bestaan uit ‘n hoë persentasie poli-onversadigde vetsure. As gevolg van die klein
hoeveelhede sitoplasma van die spermsel het dit ‘n beperkte weerstand teen reaktiewe
suurstof spesies (ROS) en is gevolglik baie sensitief vir oksidasie. Oksidasie lei tot
DNS skade/fragmentasie. DNS fragmentasie kom in spermselle van alle ejakulate voor
en is gewoonlik die gevolg van ROS produksie deur die leukosiete in die semen of
vanaf die spermselle self. Onder sekere omstandighede kan DNS fragmentasie ook
voorkom in die testis waar dit deel vorm van apoptose. Hierdie tipe DNS skade word
gesien as laat tekens van geprogrammeerde seldood (apoptose).
In oligo- en/of teratozoospermiese mans lei DNS fragmentasie tot verlaagde
implantasie- en swangerskapssyfers. Die p-patroon normale sperm morfologie groep
gee laer in vitro bevrugting en swangerskapsyfers as die g- en n-patrone. In hierdie
studie doen ons verslag oor die statisties betekenisvolle korrelasie wat gevind is tussen
die p-patroon normale sperm morfologie en DNS fragmentasie soos gemeet met die
‘terminal deoxynucleotidyl transferase-mediated dUDP-biotin end labeling’ of te wel
TUNEL toets. Hierdie bevinding is ‘n verdere verklaring vir die laer fertiliteits potensiaal
van pasiënte wat voordoen met p-patroon sperm morfologie.
‘n Verdere doel van die studie was om die moontlike verband tussen ROS in die semen,
spermatozoa DNS fragmentasie, apoptotiese status van die sperms en die motiliteits
parameters van die spermatozoa te bepaal. ‘n Positiewe korrelasie is gevind tussen
ROS en sperm apoptotiese status. Sperms met ongeframenteerde DNS is ook positief
gekorreleer met sperm konsentrasie en motiliteit. Die resultate beklemtoon die
belangrikheid van spermseleksie veral in pasiënte waar die keuse van behandeling
intrasitoplasmiese sperm inspuiting (ICSI) is.
‘n Vroeë teken van apoptose is die eksternalisering van ‘phosphatidylserine’ (PS) vanaf
die interne oppervlakte van die plasmamembraan na die eksterne oppervlak. PS het ‘n
hoë affiniteit vir Annexin V. Apoptotiese sperms het die vermoë om ‘n oösiet te bevrug, maar kan lei tot die staking van embrio deling wanneer die vaderlike gene ‘n rol begin
speel in embrio ontwikkeling. In hierdie studie het ons ‘n nuwe metode ontwikkel
waarvolgens die spermatozoa in die ejakulaat op grond van hul apoptotiese status
geskei kan word in apoptotiese en nie-apoptotiese fraksies. Die normale sperm
morfologie van die nie-apoptotiese fraksie is betekenisvol beter as dié van die
apoptotiese fraksie. Verdere verfyning van die tegniek kan daartoe lei dat dit in die
toekoms toegepas kan word om vir nie-apoptotiese sperms te selekteer veral voor die
uitvoering van ICSI.
Uit die bogenoemde is dit duidelik dat die spermsel ‘n baie belangrike rol in die
ontwikkeling van ‘n embrio, vanaf bevrugting tot implantasie en swangerskap, speel. Dit
is egter ook belangrik om in gedagte te hou dat daar ander bydraende faktore tot ‘n
suksesvolle in vitro swangerskap is, soos laboratorium toestande en embrio
kultuursisteem. Om hierdie rede is daar ook twee kultuurmedia in hierdie studie
vergelyk. Daar is bevind dat die meer komplekse medium beter kwaliteit embrios op
dag drie lewer, asook meer blastosiste en ‘n hoër swangerskapsyfer.
Dit is dus duidelik dat dit uiters belangrik is om ‘n holistiese perspektief te hê op die
komplekse faktore wat ‘n invloed mag hê op bevrugting, embrio kwaliteit asook die
swangerskapsyfer.
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Evbuomwan, I. O. "Osmoregulation in ovarian hyperstimulation syndrome (OHSS)." Thesis, University of Newcastle upon Tyne, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.246609.
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Gibson, Andrew Robert. "The impact of the child welfare principle on access to assisted reproductive technology." Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/6716/.
Full textAbstract:
Assisted Reproductive Technology has, in the last 40 years, raised numerous ethical questions. One of these ethical questions has been whether or not children born as a result of Assisted Reproductive Technology treatments may be harmed as a consequence of being brought into existence in this way. Harm caused to children is quite rightly a serious concern for society and society expects the State to intervene to protect children from parents who pose a significant risk to their children. Towards this end section 13(5) of the Human Fertilisation and Embryology Act 1990 requires licensed infertility treatment clinics to ‘take into account the welfare of the child who may be born as a result of treatment’ when considering whether or not to provide a woman with treatment services. This thesis will argue that section 13(5) of the Human Fertilisation and Embryology Act 1990 should be amended as it is acts as nothing more than an arbitrary and unjustified infringement on an individual’s right to reproductive liberty; is an ineffectual means of promoting the welfare of the child who may be born as a result of treatment; is philosophically incoherent; and is inconsistent with the law as applied in so-called ‘wrongful life’ cases. The argument that section 13(5) of the Human Fertilisation and Embryology Act 1990 should be amended will be grounded upon the contention that an individual’s right to reproductive liberty should be accorded particular respect. This thesis will argue for a right to reproductive liberty which encompasses a negative right of the individual to be free from unjustified interference by the State when making reproductive choices. The pervasive influence of the child welfare principle as applied in the context of decisions directly impacting upon them has, it will be argued, played a significant part in the inclusion and retention of section 13(5) within the Human Fertilisation and Embryology Act 1990. This thesis will examine the way in which the child welfare principle as applied to children has grown in influence and how an unquestioning adherence to this worthy principle has led to an incongruous version of it being applied at the pre-conception stage. While the State have a solid mandate to protect the welfare of children this thesis will argue that that mandate cannot realistically be extended to apply to future children, when to refuse an individual access to Assisted Reproductive Technology has the effect of preventing the child whose welfare is to be taken into account from being brought into existence in the first place.
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Davidson, Lien M. "Infra-red laser applications in the reproductive sciences : improving safety for assisted reproductive technology and developing novel research tools." Thesis, University of Oxford, 2017. http://ora.ox.ac.uk/objects/uuid:7472f917-7bf2-4a5d-81e1-16b179cfd0f6.
Full textAbstract:
Assisted reproductive technology (ART) has been rapidly expanding since the birth of Louise Brown, the first test tube baby, in 1978. Although an increasingly complex array of laboratory skills and procedures have been developed for infertility treatments, the success rate of ART remains low. In an attempt to make ART safer and more efficient, international medical practice is trending towards single embryo transfers and the use of innovative, sophisticated technologies to identify promising gametes and embryos with the highest potential to generate a pregnancy. Laser technology is increasingly being used to accomplish these aims. The application of lasers for ART has been successfully employed in clinical practice for some time now and is continually the subject of investigative research in order to generate new methods to improve operations. Moreover, lasers serve as a powerful tool at the forefront of investigative research in the reproductive sciences, assisting in broadening our understanding of reproductive and developmental biology. Nevertheless, there is a paucity of literature pertaining to the safe standardisation of such laser procedures with evidence at the molecular level. The primary aim of this thesis was to optimise applications of laser technology for clinical ART and research applications in the reproductive sciences. This thesis utilised the mouse embryo model to investigate potential deleterious effects of different laser treatment applications, both by the operator and hardware manufacturer. Safe and unsafe laser operator parameters were elucidated by assessing deleterious effects to the plasma membrane integrity, blastocyst survival rate, DNA fragmentation levels, and changes in gene expression of key developmental genes. The effect of altering the laser hardware to lower the power output was evaluated and it was determined that if a lower power laser is used to deliver a set amount of energy over a longer period of time, a smaller amount of damage is incurred. Work in this thesis also established a new method in which laser technology can be used as a research tool for the reproductive sciences, by creating a novel stimuli-responsive laser-activated nanoparticle delivery system with spatial control and increased efficiency in a mammalian cell model. The field of reproductive science continues to benefit greatly from laser application clinically to improve infertility treatments, and in research, to elucidate mechanisms underlying infertility, with a hope of increasing our understanding and eventually developing new treatment options.
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Morris, Akilah. "KNOWLEDGE, INTENTIONS, AND BELIEFS ABOUT FERTILITY AND ASSISTED REPRODUCTIVE TECHNOLOGY AMONG ILLINOIS COLLEGE STUDENTS." OpenSIUC, 2018. https://opensiuc.lib.siu.edu/dissertations/1595.
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AN ABSTRACT OF THE DISSERTATION OF AKILAH MORRIS SMITH, for the Doctor of Philosophy degree in Public Health, presented on April 11th 2018, at Southern Illinois University Carbondale. TITLE: KNOWLEDGE, INTENTIONS, AND BELIEFS ABOUT FERTILITY AND ASSISTED REPRODUCTIVE TECHNOLOGY AMONG ILLINOIS COLLEGE STUDENTS MAJOR PROFESSOR: Roberta Ogletree H.S.D and Juliane P. Wallace PhD The purpose of this quantitative cross sectional study was to examine knowledge, beliefs, and intentions about fertility and assisted reproductive technology among college students. This study differs from previous studies in that it examines knowledge, beliefs, and intentions about fertility and assisted reproductive technology among Illinois college students. Five hundred thirty six undergraduate students from six Illinois universities taking foundational health courses participated in this convenience sample study. Participants included three hundred and five females, 225 males, and five transgender students. The age ranges from 18-60. Five hundred and twenty students were childless. Three hundred and eleven students were single, 195 were in a committed relationship, and 16 were married. An Analysis of Variance (ANOVA) detected the differences among college students’ knowledge, beliefs, and intentions, based on race, sexual orientation, age, parental status, relationship status, and gender. Additionally Multiple Linear Regression analysis determined variations among race, sexual orientation, age, parental status, relationship status, and gender based on intentions, beliefs, and knowledge of fertility and ART treatment options. The first findings indicate that age, race and relationship status variables strongly impacted fertility intentions. The second findings reveal that gender and race impact beliefs influencing fertility and ART treatment options. None of the six variables significantly affected knowledge, which does not correlate with the literature. The students replied that they were not informed about women’s fertility as well as ART treatment options. Caucasians and older students’ intended on delaying parenthood supports the current literatures. According to Martinez, Daniels, and Chandra (2012), Caucasians are more likely to delay parenthood, which this research study supports. Secondly, Caucasians and males students had beliefs that supported the delaying of parenthood. Amongst the six groups, none of the groups affected knowledge. Daniluk and Koert (2012) show that while college student’s lack knowledge researchers are not sure what strongly predict their fertility and ART knowledge treatments.
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Wong, Yim-kuk Aileen. "Stress and coping for women from infertility to assisted reproductive treatments /." Hong Kong : University of Hong Kong, 2000. http://sunzi.lib.hku.hk/hkuto/record.jsp?B22331529.
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Santos, Gomes Barbara Micaela. "Development of novel tools for assisted reproductive technologies based on electrically switchable surfaces." Thesis, University of Birmingham, 2018. http://etheses.bham.ac.uk//id/eprint/8690/.
Full textAbstract:
A variety of stimuli have been explored in the last few decades to develop dynamic interfaces with biotechnological and biomedical applications, such as biosensors, point of care devices, cell behaviour control and tissue engineering. In this work, the use of an electrical stimulus was explored for the development of a smart switchable surface with the ability to, in an on-demand fashion, expose and conceal progesterone - an ovarian steroid hormone which plays a crucial role as a modulator of sperm function. In this system, an electric potential drives a conformational change in the surface bound peptide moiety with fast response time. Focus was given to the design of a device that could be used in assisted reproductive treatments and grown into a commercially marketable product. Whilst being developed for assessment of sperm quality and fertilizing potential, the application of this system can be widely extended as this approach can be applied to other relevant antigen-antibody systems, which have so far only been evaluated in static conditions. Fabrication of a micropatterned surface was performed and a novel method for orthogonal functionalisation of gold and glass was developed, where gold was functionalised with a polyethylene glycol thiol self-assembled monolayer (SAM) and glass was functionalised with a covalently bound poly-d-lysine layer for sperm cell attachment. In addition to the investigations on SAMs and mixed SAMs formed on gold, silicon and glass substrates, studies with fluospheres were also undertaken. These tools are aimed to be used for further studies with cells, namely the investigation of their response in terms of Ca2+ signalling, a key player in the regulation of sperm function.
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Yelumalai, Suseela. "Potential effects of assisted reproductive technology upon the abundance and localisation of two vital sperm proteins." Thesis, University of Oxford, 2015. http://ora.ox.ac.uk/objects/uuid:be57f123-c6dc-4cc8-ae53-1f32716cc1e5.
Full textAbstract:
Assisted reproductive technology (ART) uses advanced techniques such as in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) to combat human infertility. However, the success rate of ART is poor and can, at least in part, be attributed to detrimental (iatrogenic) damage incurred by gametes and embryos during laboratory treatment or manipulation, thus compromising their functional role and reducing the chances of fertilisation. The sperm plays two fundamental roles upon gamete fusion: (1) to deliver paternal genomic DNA of optimal integrity into the oocyte, and (2) to activate the oocyte to initiate embryogenesis. Protamine and phospholipase C zeta (PLCζ) are two critical sperm proteins fundamentally responsible for facilitating these two key roles, respectively. The essential role of these sperm proteins with regards to male fertility, and fertilisation outcome following ART treatment, has been widely reported. This thesis was predominantly designed to investigate the potential effects of cryopreservation and sperm immobilisation via polyvinylpyrrolidone (PVP) upon the abundance and localisation of protamine and PLCζ in mouse and human sperm, respectively. Deficiency of these proteins could lead to reduced sperm DNA integrity and oocyte activation ability, respectively. An immunofluorescent quantitative assay was first designed and optimised for the determination of protamine 1 (P1) and 2 (P2) levels in sperm. This assay demonstrated that the total levels of P1 and P2, but not the P1:P2 ratio, were significantly reduced (by approximately 50%) in mouse sperm following cryopreservation. This novel assay may represent a useful clinical tool to predict DNA integrity and help select sperm with the best quality DNA. Clinical screening of PLCζ was also carried out in the largest dataset reported to date and confirmed that total levels of PLCζ in human sperm varied significantly between samples (P ≤ 0.05). Cluster analysis led to the development of a PLCζ scoring system with significant potential as a clinical prognostic and diagnostic assay. Regression models also correlated fertilisation rate and PLCζ content in a total of 30 clinical samples. Collectively, these novel tools show significant promise as predictors of oocyte activation ability. Specific case studies involving vasectomy, oocyte activation deficiency (OAD), and globozoospermia, were identified and shown to be associated with significantly reduced levels of PLCζ (P ≤ 0.05). In two of these case studies, a single nucleotide polymorphism (SNP) was identified in the PLCζ promoter region, potentially indicating a novel mechanism for PLCζ expression in human sperm. Another case of OAD suggested the apparent deficiency of a crucial interacting factor in the oocyte, emphasising that OAD is not exclusively linked to sperm abnormalities. For the first time, efforts were made to assess whether PLCζ expression was linked to male age; total levels and the proportion of sperm exhibiting PLCζ were found not to differ significantly amongst a total of 46 males. Furthermore, in a pilot experiment, levels of PLCζ were significantly reduced (by 23% to 89%) in PVP-treated sperm from 9 controls and 3 infertile patients, with patient sperm showing higher susceptibility to the effects of PVP compared to controls. However, a more robust experiment featuring sperm from 16 fertile donors, failed to show any significant effect of PVP upon PLCζ. Collectively, data arising from this thesis generated a series of potential clinical tools to quantify protamine and PLCζ in sperm, provides strong evidence that levels of protamine are significantly reduced by cryopreservation, and has provided at least some evidence that PVP may cause detrimental effect upon the level of PLCζ in human sperm. Further work on the effects of vasectomy and the relative functional importance of the SNP detected in the PLCζ promoter are highly warranted. Further investigation and clinical translation of these findings may help to improve the success rate of ART.
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Brodin, Thomas. "Ovarian Reserve and Assisted Reproduction." Doctoral thesis, Uppsala universitet, Obstetrik & gynekologi, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-192998.
Full textAbstract:
Treatment success in IVF-ICSI is mainly limited by female age, but differences in ovarian reserve (OR; the remaining pool of oocytes and their quality) between individuals modify treatment prerequisites among women of similar age. OR may be assessed by OR tests (ORTs). The main aims of this work were to study menstrual cycle length (MCL), basal levels of circulating gonadotrophins, antral follicle count (AFC) and serum Anti-Müllerian hormone (AMH) levels and their associations with and prognostic capacities regarding IVF-ICSI outcome in large cohorts of unselected women. Age-adjusted MCL was positively and linearly associated with pregnancy rates (PRs), live-birth rates (LBRs) and ovarian response to controlled ovarian hyperstimulation. An MCL of >34 days almost doubled the LBR compared with an MCL of <26 days. The grouped variable ‘combined FSH and LH levels’ was superior to both individual gonadotrophin levels and the LH:FSH ratio. The highest mean PR was seen in connection with a combination of FSH <6.7 U/l with LH >4.9 U/l; PRs were lowest when FSH-LH levels were opposite to this (high-low) and intermediate when FSH-LH levels were low-low or high-high. Associations with LBR and ovarian response were similar as those for PR. AFCs and serum AMH levels were positively and log-linearly associated with PR, LBR and ovarian response. Success rates levelled out above AFC 30 or AMH 5 ng/ml. Treatment outcome was superior among women with polycystic ovaries. Among the studied ORTs, logAFC and logAMH concentration correlated most strongly. After multivariate testing, entering all studied ORTs, AMH and female age remained independently associated with LBR. AMH + AFC + age predicted both poor and excessive ovarian responses with high accuracy. Adjusting for age and oocyte yield, all ORTs remained significant for LBR, implying that ORTs also capture information on oocyte quality. In conclusion, measures of OR are strongly associated with PR, LBR and ovarian response in a log-linear fashion, and partly reflect oocyte quality. The OR spectrum is continuous, from small ‘oligofollicular’ ovaries (the low extreme) to polycystic ovaries (the high extreme). Among the studied ORTs, AMH together with age provide the most powerful basal estimate for IVF/ICSI outcome.
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Bailey, Vicki E. "Ethical considerations for Christian couples facing infertility and weighing the possibilities offered by assisted reproductive technology." Online full text .pdf document, available to Fuller patrons only, 1999. http://www.tren.com.
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Dooley, Brigitte A. "ATTITUDES TOWARD ASSISTED REPRODUCTIVE TECHNOLOGY: THE EFFECTS OF GENDER, RELATIONSHIP STATUS, AGE, AND SEXUAL ORIENTATION." UKnowledge, 2014. http://uknowledge.uky.edu/hes_etds/11.
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Reproductive technology has extended procreative options to infertile, subfertile, unpartnered, and same-sex-partnered individuals, but this technology is sometimes used in circumstances that may be deemed unreasonable or inappropriate by some people. The purpose of this study was to assess the effects of five contextual variables—gender, relationship status, age, and sexual orientation of the individual or couple seeking reproductive assistance, as well as the source of gametes—on attitudes toward the procurement of reproductive services. A multiple-segment factorial vignette was administered to a sample of 257 reproductive-aged respondents. Results indicate that ART is generally viewed as an acceptable procedure by reproductive aged individuals, particularly in normative contexts with regard to age and marital status, but differences between single men and single women using ART services were surprising and the effects of sexual orientation were both complex and unexpected. As reproductive norms and medical advances change over time, ethical questions will continue to arise and be discussed by professionals and lay commentators alike. The findings reported here can inform those discussions, while also generating new research to make sense out of the surprising results.
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Boshoff, Gerhardus Marthinus. "Investigating a novel in vitro embryo culture system – The Walking Egg Affordable Assisted Reproductive Technology." Diss., University of Pretoria, 2017. http://hdl.handle.net/2263/63049.
Full textAbstract:
Introduction: The desire to have a biological child transcends race, religion and
socio-economic status. However for those faced with infertility, the financial
resources needed to conceive are often not available. Current research in assisted
reproduction has gravitated towards cost reduction to address restricting financial
factors, without compromising quality of treatment. One such initiative is the
development of a low-cost embryo culture method by The Walking Egg foundation.
This method utilizes a standard chemical reaction and simple equipment to
equilibrate culture media pH and to regulate temperature; both aspects were
investigated in this study. An exploration into the insemination concentration to
achieve oocyte fertilization was also undertaken.
Methods: Quality control of temperature regulation on six different heating devices,
including a comparison of inter- and intra-variations was carried out. The utilization
of citric acid and bicarbonate of soda for carbon dioxide production, which
subsequently facilitate setting of pH values, was tested by injecting increasing citric
acid volumes (1.2 ml – 3.0 ml in 0.2 ml increments) into set volumes of bicarbonate
of soda. Further investigation evaluated gas production at various temperatures
(37°C, 25°C and 15°C), at increasing intervals (16 – 30 hours) of equilibration and
these were compared by measuring pH of the culture media. The influence of
altitude on pH was explored by repeating the chemical reaction experiment at five
different locations in South Africa. Furthermore, the addition of water to citric acid
before gas generation was explored.
The minimal insemination concentration needed for fertilization was determined by
the addition of decreasing numbers of spermatozoa to non-fertilized bisected
oocytes. The experiment was repeated with a selected sperm insemination number
in 1 ml or 50 μl culture media to compare the tested culture system with conventional
culture. Spermatozoa bound to the hemi-zonae were counted with the aid of an
inverted phase contrast microscope. Hemi-zonae with bound sperm were also
stained with ethidium homodimer and evaluated using a confocal laser-scanning
microscopy system. After removal of hemi-zonae, the spermatozoa in culture were
isolated for deoxyribonucleic acid fragmentation analyses and reactive oxygen species presence in the culture media was measured. Additionally, reactive oxygen
species generation in simulated culture was measured over time.
Results: All the equipment tested bar one, the warming oven, proved useable with
the simplified Walking Egg in vitro fertilization culture system. By decreasing the
citric acid volumes, it was indicated that 1.8 ml citric acid, diluted with 1.2 ml water, is
the optimal volume to facilitate the required culture media pH. Omitting the water
dilution from citric acid volumes affected the culture media pH adversely, however
reducing the temperature during gas equilibration did not. A change in altitude had
no effect on culture media pH.
Lower insemination numbers resulted in decreased sperm binding, with
2 x 103 motile sperm insemination providing the lowest number to still obtain
sufficient sperm–zona binding (≥20 sperm bound). Incubation in 1 ml vs. 200 μl
culture media indicated decrease in sperm bound. Sperm deoxyribonucleic acid
fragmentation and the presence of reactive oxygen species in the culture media were
similar in both the test and control groups. A comparison over time revealed less
reactive oxygen species in 1 ml culture media, from the simplified Walking Egg in
vitro fertilization culture system after three days of culture, than 200 μl culture media
drops under oil, from conventional culture after 18 hours, however the results were
not statistically significant.
Discussion: Purpose-made heating devices provide superior stabilization of culture
media temperature. When selecting a heating device, intra-variations should be
considered. Culture media can be manipulated to the required pH by carbon dioxide
production, with meticulous attention paid to the citric acid volumes used. However,
if gas generation is performed at room temperature, equilibration time must be
increased. In conventional culture, the minimum insemination number can be reduced to 2 x 103
motile sperm. Due to lower binding of sperm in large volumes of culture media,
2 – 5 x 103 motile sperm should be considered for the simplified culture system,
depending on a holistic consideration of all sperm parameters. Extended culture for
at least three days with the simplified culture system can be performed without increasing reactive oxygen species present in culture media. Further research of this
novel culture method should include the application of the culture method in a South
African environment.<br>Dissertation (MSc)--University of Pretoria, 2017.<br>Obstetrics and Gynaecology<br>MSc<br>Unrestricted
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Li, Zhuoyang. "Fertility and pregnancy outcomes following fresh versus frozen-thawed embryo transfer in assisted reproductive technology." Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/20330.
Full textAbstract:
Background and aims: Assisted reproductive technology has provided great hope for millions of infertile couples. In recent years, frozen-thawed embryo transfer has no longer been merely an add-on to the conventional fresh embryo transfer. Transfer of a cryopreserved embryo has contributed to nearly half of the embryo transfer cycles in Australia. The aim of this thesis is to evaluate the fertility and pregnancy outcomes following fresh versus frozen-thawed embryo transfer. Materials and methods: The thesis includes four studies using population-based data extracted from Australian and New Zealand Assisted Reproduction Database and Victorian Assisted Reproductive Treatment Authority. The risks of ectopic pregnancy, small/large for gestational age birth, and cycle-based live birth following frozen-thawed embryo transfer were compared with those of fresh embryo transfer. This thesis also investigated the cumulative live birth rate from one oocyte retrieval following a ‘fresh transfer’ strategy versus a ‘freeze-all’ strategy. Results: Compared with fresh embryo transfer, frozen-thawed embryo transfer was associated with a decreased risk of ectopic pregnancy and small for gestational age birth, but an increased risk of large for gestational age birth. The ‘freeze-all’ strategy resulted in a similar cumulative live birth rate as the ‘fresh transfer’ strategy among high responders (>15 oocytes), but did not benefit normal (10–15 oocytes) and suboptimal responders (<10 oocytes). Vitrification was the preferred cryopreservation method for blastocysts. Conclusion: This thesis provides population-based evidence of fertility and pregnancy outcomes following fresh versus frozen-thawed embryo transfer. This thesis suggests that, from a population perspective, the ‘freeze-all’ strategy may benefit some subgroups of patients, but should not be offered universally.
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Wong, Yim-kuk Aileen, and 黃艷菊. "Stress and coping for women from infertility to assisted reproductive treatments." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2000. http://hub.hku.hk/bib/B31250907.
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Herbert, Danielle. "Fertility and infertility : studies in reproductive epidemiology in Australia." Thesis, The University of Queensland, 2011. http://espace.library.uq.edu.au/view/UQ:227862.
Full textAbstract:
Worldwide, there are few large-scale epidemiological studies on infertility. In Australia, population-based research on infertility is limited to a few small-scale studies. Therefore, the prevalence of infertility and unmet need for specialist medical advice and treatment cannot be estimated reliably. Women who have used assisted reproductive technologies (ART) are recorded in treatment registries. However, there are many infertile women who are excluded from these clinical populations because they neither seek advice nor use treatment. The thesis was based on a biopsychosocial model of health and used the methods of reproductive epidemiology to address the lack of national data on the prevalence of infertility in Australia.
Firstly, numbers of births and pregnancy losses were investigated in two generations of women participating in the Australian Longitudinal Study on Women’s Health (ALSWH). The ALSWH is a broad-ranging, longitudinal examination of biological, psychological and social factors that impact on women’s health and wellbeing. Women from three age cohorts were randomly sampled from the population using the universal public health insurance (i.e., Medicare) database and ALSWH participants were representative of the female population. However, the studies in the thesis only involved data from two cohorts. The younger cohort were born in 1973-78 and completed up to four mailed surveys between 1996 (when they were aged 18-23 years, n=14247) and 2006 (28-33 years, n=9145). The mid-aged cohort were born in 1946-51 and completed four mailed surveys between 1996 (when they were aged 45-50 years n=13715) and 2004 (53-58 years, n=10905).
Compared to other studies that focus on outcomes of single pregnancies, these studies included all pregnancy outcomes by developing comprehensive reproductive histories for each woman. Pregnancy outcomes included birth, miscarriage, stillbirth, termination and ectopic pregnancy. Women in the youngest cohort (born in 1973-78) were only just reaching their peak childbearing years and many (44%) had yet to report their first pregnancy outcome. Women from the mid-aged cohort (born 1946-51) had completed their reproductive lives and 92% were able to report on their lifetime pregnancy outcomes. Pregnancy losses, especially miscarriage, were common for both generations of women.
Secondly, the prevalence of infertility, seeking medical advice and using treatment was identified for these two generations of women. For the older generation, the lifetime prevalence of infertility and demand for treatment was investigated in the context of the specialist medical services which became available circa 1980. By this time, however, most of these older women had already been pregnant and completed their families. For women who experienced infertility (11%), their options for advice and treatment were limited and less than half (42%) had used any treatment. More recently for the younger generation of women, who were aged 28-33 years in 2006, specialist advice and treatment were extensively available. Among women who had tried to conceive or had been pregnant (n=5936), 17% had experienced infertility and the majority (72%) were able to access medical advice. However, after seeking advice only half of these infertile women had used treatment with fertility hormones or in vitro fertilisation (IVF). Overall for infertile women aged up to 33 years, only one-third had used these treatments.
Thirdly, the barriers to accessing medical advice and using treatment for infertility were identified for women aged less than 34 years. Among a community sample of infertile women aged 28-33 years (ALSWH participants), self-reported depression was found to be a barrier to accessing medical advice. The characteristics of these infertile women in the community who had (n=121) or had not (n=110) used treatment were compared to infertile women aged 27-33 years (n=59) attending four fertility clinics. Compared to infertile women in the community, living in major cities and having private health insurance were associated with early use of treatment for infertility at specialist clinics by women aged <34 years. In contrast to most clinical studies of IVF, the final study reported in the thesis took into account repeated IVF cycles and the impact of women’s individual histories on IVF outcomes. Among 121 infertile women (aged 27-46 years) who had
286 IVF cycles, older age and prolonged use of the oral contraceptive pill were associated with fewer eggs collected. Further, women in particular occupations had lower proportions of eggs fertilised normally than women in other occupational groups.
These studies form the first large-scale epidemiological examination of infertility in Australia. The finding that two-thirds of women with infertility had not used treatment indicates that there is an unmet need for specialist treatment in women aged less than 34 years. However, barriers to accessing treatment prevent women using ART at a younger age when there is a higher chance of pregnancy.
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Peters, Kathleen, and k. peters@uws edu au. "Misguided hope: a narrative analysis of couples' stories of childlessness despite treatment with assisted reproductive technology." Flinders University. School of Nursing and Midwifery, 2006. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20061011.123633.
Full textAbstract:
Abstract
Societal expectations for procreation often result in infertile couples accessing assisted reproductive technology (ART). In the current state of this technology, the successful outcome of the birth of a child does not always occur. This study contributes to nurses' understanding of what it is like for couples to remain involuntarily and permanently childless after infertility treatment has ended, and aims to bring about change in attitudes and practice towards this group. Literature that acknowledges individuality as well as shared experience for couples who remain childless after infertility treatment is scarce. Health professionals may therefore encounter difficulties in providing this group with appropriate support.
This research used a qualitative approach informed by feminist perspectives to gather stories of five couples' experiences of childlessness after accessing ART. Individual conversations with both members of the marital partnership were recorded, transcribed and analysed.
The study found that due to the societal expectation of procreation, and the falsely elevated 'success rates' of ART, couples often delayed decisions about whether they should persevere with treatment, hence reducing the possibility of exploring alternative methods of parenting. As well as highlighting the ambiguity of the term 'success', the study suggests that the hope that technology brings childless couples prolongs decision making and simultaneously serves to compound the sense of failure experienced by these couples. The couples' engagement with ART, as well as their inability to conform to the normative family of parents and their biological children, also contributed to periods of isolation. Following the decision to remain childless, the participants found that setting achievable and challenging goals assisted in re-building their self-esteem, and enhanced the process of adapting to their life without children. Although participant couples expressed obvious grief at remaining childless, they also showed resilience by managing attached difficulties and stigmatisation, and by creating positive future outcomes. For these childless couples, the strength of their relationships was seen as critical in the process of overcoming adversity. This study suggests ART clinics should provide more realistic information to individual couples regarding the likelihood of taking home a baby. Further to this, independent counselling support is recommended for couples prior to and during ART treatment, and when this treatment is ceased.
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Sakian, Sina. "Investigation of methylation and gene expression in placenta of pregnancies conceived by assisted reproductive technology (ART)." Thesis, University of British Columbia, 2011. http://hdl.handle.net/2429/31191.
Full textAbstract:
With the increasing use of assisted reproductive techniques (ART) every year, concerns have been raised regarding the possible effect these procedures have on the health of the children procured by them. Although patients born via ART are usually healthy, studies have associated these procedures with increased incidence of low birth weight (LBW), chromosomal abnormalities, birth defects and imprinting disorders. No study has proposed a single defined cause for any of these defects in ART infants, however it is believed that they may be due to both the invasiveness of ART and to genetic defects that are at the root of the infertility in the parents. In this study, changes in the methylation of the H19 and IGF2 imprinting control region 1 (ICR1) were investigated for both ART (n=92) and naturally conceived controls (n=19) using pyrosequencing. Expression of H19 and IGF2 was also investigated for both the ART population (n=31) and controls (n=14) using quantitative real-time PCR.
No significant changes in H19 or IGF2 methylation or gene expression were found between the ART groups and the natural conception group. Methylation levels at ICR1 for the IVF, ICSI and control cases were averaged at 49.3% ±3.4%, 49.6%±1.9% and 48.7%±1.7%, respectively. Compared to the controls IVF and ICSI patients both showed an increase in H19 gene expression (by a factor of 1.78±0.74 and 1.93±0.71, respectively) while showing a decrease (by a factor of 0.83±0.34 and 0.74±0.27, respectively) for the expression of IGF2; these differences were not proven significant using ANOVA (P > 0.05). The study did find, however, that the previously proposed H19 and IGF2 regulatory model is not a good indicator of how these two genes are controlled in human placenta. Comparing methylation analysis with expression analysis did not show the expected negative correlation implying that there may be other factors influencing the expression of H19 and IGF2 in human placental tissue. Although our results suggest that ART does not have a significant negative effect on H19 and IGF2 imprinting in the placenta, it merits further investigation looking at the regulation of these two genes in this tissue.
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Kruger, Theunis Frans. "The role of sperm morphology in assisted reproduction (ART)." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71682.
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Cornet, Bartolomé David. "Molecular determinants of human oocyte quality in assisted reproduction." Doctoral thesis, Universitat de Barcelona, 2019. http://hdl.handle.net/10803/667566.
Full textAbstract:
Infertility, defined by the World Health Organization (WHO) as the inability to conceive after a year of unprotected sex, is a disease that affects 1 in 9 couples of reproductive age worldwide. Most of these couples will only achieve pregnancy through assisted reproduction techniques. In recent decades, many improvements have been made in this field, but no method has been able to achieve 100% success. There are many variables that could affect the outcome of assisted reproduction cycles, one of the most important is the quality of the woman's oocytes. Maternal age is the most important factor affecting women’s ability to conceive and give birth, since female reproductive aging is associated with reduced oocyte quality; however, the underlying molecular mechanisms remain poorly understood. It is also well established that as woman age increases, her ovarian reserve diminishes. However, the role of ovarian reserve in the decline of oocyte quality with age is currently unknown.
The developmental competence of an oocyte is its ability to sustain embryonic development until embryonic genome activation. It is determined by the transcripts (coding and non-coding RNAs) accumulated during oocyte maturation. The lack of transcription during final oocyte maturation suggests that regulation of the genes involved in this process occurs at the post-transcriptional level. Among the possible mechanisms, alternative splicing (AS) of the messenger RNA could be involved. Studying oocyte gene expression and the spliced mRNA isoforms might provide novel information on the molecular mechanisms driving early development, and might be a source of potential biomarkers of oocyte quality.
The main objective of this thesis is to explore new possibilities for the identification of oocyte quality biomarkers at the molecular level in order to better understand the oocyte and how its developmental competence can be improved. For this, the results of oocytes from women with different age and ovarian reserve have been compared. In addition, to identify non-invasive biomarkers for oocyte developmental competence, the evaluation of the association between the expression analysis of different aging markers in human cumulus cells (CCs), the age and ovarian reserve and the oocyte maturation rates was conducted. Finally, because many of the oocytes used were vitrified, the effect of vitrification on oocyte developmental competence was analysed by comparing the reproductive outcomes of fresh and vitrified oocytes from the same stimulation cycle.
The results suggest an important role for ncRNAs and alternative splicing in human oocyte biology. Age and ovarian reserve have been shown to independently affect the ncRNAs transcriptome of in vivo matured oocytes. These results might provide valuable information for the search of oocyte quality markers, and for the (re)interpretation of existing dataset. On the other hand, differences in transcribed splicing variants can also provide biomarkers of oocyte quality, since the profile of confirmed AS events could determine the specific transcriptome of the mature oocyte.
The expression of common somatic aging markers in CCs didn’t show a clear correlation between the analysed genes and age, suggesting that CCs of reproductively old women do not present the typical transcriptome of aged tissues. In addition, when looking at future clinical applications, these markers have not been found useful for the development of non-invasive markers for oocyte developmental competence, since no correlation was observed either with the ovarian reserve or the oocyte maturation rates.
Finally, this study showed that oocyte vitrification per se maintained the developmental potential of human oocytes within a reasonable biological range, clinically comparable to fresh oocytes. As a consequence, we established that the main reason for the reported lower clinical results in vitrified cycles has to be attributed to the loss of oocytes during the warming step. This has important repercussions in the clinical practice, as measures can be easily put in place to offset oocyte loss.<br>La competencia de desarrollo ovocitaria se define como la capacidad del ovocito para mantener el desarrollo embrionario hasta que el embrión activa su propio genoma. Está determinada por los transcritos (ARN codificantes y no codificantes) acumulados durante la maduración de los ovocitos. La falta de transcripción durante la maduración final de los ovocitos sugiere que la regulación de los genes involucrados en este proceso ocurre a nivel postranscripcional. Entre los posibles mecanismos, el “splicing alternativo” del ARN mensajero, podría estar involucrado.
El objetivo principal de esta tesis es explorar nuevas posibilidades para la identificación de biomarcadores de calidad de ovocitos a nivel molecular con el fin de comprender mejor el ovocito y cómo se puede mejorar su competencia de desarrollo. Además, para identificar biomarcadores no invasivos de la competencia de desarrollo de ovocitos, se ha evaluado la expresión de diferentes marcadores de envejecimiento somático en células de cúmulos humanos que rodean los ovocitos, y se ha correlacionado con la edad y la reserva ovárica de las mujeres y con las tasas de maduración de los ovocitos. Finalmente, debido a que muchos de los ovocitos utilizados estaban vitrificados, se ha analizado el efecto de la vitrificación sobre la competencia de desarrollo de los ovocitos comparando los resultados reproductivos de ovocitos frescos y vitrificados del mismo ciclo de estimulación.
Los resultados sugieren que los ARNs no codificantes y el splicing alternativo representan un papel importante en el proceso de adquisición de la competencia de desarrollo en ovocitos humanos. Estos resultados pueden proporcionar información valiosa para la búsqueda de marcadores de calidad de ovocitos y para la (re)-interpretación de conjuntos de datos existentes. El estudio de la expresión de marcadores de envejecimiento somático en células de cúmulos humanos no ha mostrado una clara correlación entre los genes analizados y la edad, lo que sugiere que las células del cúmulo de mujeres de edad reproductiva avanzada no presentan el transcriptoma típico de los tejidos envejecidos. Finalmente, este estudio ha demostrado que la vitrificación de ovocitos mantiene per se el potencial de desarrollo de los ovocitos humanos dentro de un rango biológico razonable, clínicamente comparable a los ovocitos frescos.
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Fasano, Giovanna. "Contribution of vitrification to human assisted reproduction." Doctoral thesis, Universite Libre de Bruxelles, 2013. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209484.
Full textAbstract:
La cryopréservation, dans le domaine de la reproduction médicalement assistée, constitue depuis de nombreuses années une branche suscitant beaucoup d’intérêts et d’espoirs. En effet, de nombreuses équipes de recherche se sont attelées à mettre au point et à améliorer des protocoles permettant de conserver les gamètes, les embryons et les tissus reproducteurs.<p>Malgré le fait que la cryopréservation soit une technique très attractive, elle peut avoir des effets délétères sur les cellules. Les protocoles expérimentaux visent donc à minimiser ces effets afin d’augmenter la survie et la compétence cellulaire après décongélation.<p><p>Les deux méthodes les plus utilisées, la congélation lente et la vitrification, présentent chacune des avantages et des inconvénients. En effet, la première ne permet pas d’éliminer la cristallisation intracellulaire. Quant à la seconde, elle empêche la formation de cristaux de glace mais pourrait provoquer une toxicité due à la forte concentration des cryoprotecteurs. <p><p>Cette thèse de doctorat propose plusieurs objectifs :<p><p>•\<br>Doctorat en Sciences biomédicales et pharmaceutiques<br>info:eu-repo/semantics/nonPublished
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Salah, Wed Mohammed K. "Impact of Assisted Reproductive Technology on the Expression of Epigenetic Marker Histone 3 Lysine 9 in Zygotes." Thesis, The University of Sydney, 2022. https://hdl.handle.net/2123/29256.
Full textAbstract:
Normal zygotic maturation entails significant chromatin remodelling and epigenetic reprogramming of parental genomes to provide the framework for embryonic genome activation during the second cell cycle. Embryonic genome activation is required for proper embryonic development and involves a shift from maternal to embryonic regulation of gene transcription. Activation of the embryonic genome necessitates the transformation of chromatin from a transcriptionally repressed to active state. This event is disrupted by environmental factors such as culture in vitro, resulting in decreased embryonic viability. The biochemical reason for this is, however, unknown.
Dynamic alterations in histone 3 acetylation on lysine 9 (H3K9ac) occur throughout preimplantation embryo development, because they are undetectable in oocytes and embryos that have just been fertilised. H3K9ac is detected around the time of first DNA replication (pronuclear stage 3) and increases in amount during preimplantation growth. H3K9ac is frequently connected with changing chromatin conformation to an active state. An increasing body of research suggests that modifications to an early embryo’s development environment, such as those that occur in assisted reproduction technologies (ART), can disrupt the usual processes of epigenetic reprogramming, which can lead to maladaptive lifetime changes in an organism’s homoeostasis.
Aim
This research aims to evaluate the influence of different in vitro conditions on zygotes, mimicking some ART steps, on the level of histone modification H3K9ac and chromatin configuration under different treatment conditions, and to determine if DNA is cross-linked to H3K9ac in preimplantation embryos using immune-localisation studies.
Results
Embryos obtained through IVF have greater H3K9ac levels than embryos obtained through natural mating. The opposite occurs when the culture time between IVF and embryos acquired by natural mating is the same. In embryos obtained through natural mating, shortening the insemination duration increases levels of H3K9ac. Embryos generated by IVF have lower levels of H3K9ac disturbance when cultured in an optimal medium. Additionally, the use of sequential media (placing a zygote in a fresh drop of medium after a period of culture) results in lower levels of H3K9ac, compared with a single step (where a zygote remains in a single drop of culture medium for the duration of culture) when an optimal medium (kSOM+AA) is used. A suboptimal single step medium (mod-HTF) manifests lower levels of H3K9ac than when using the same medium in a sequential manner. Using a suboptimal medium (mod-HTF) in the first 4 hours (h) of culture results in higher levels of H3K9ac than when using it in the second 4 h of culture, when combined with an optimal medium (kSOM+AA). Conversely, maturity alone did not cause any H3K9ac disturbance. However, when combining superovulation and age, younger mice showed higher levels of H3K9ac when compared with older mice that had not been superovulated. Zygotes from older superovulated females had lower levels of H3K9ac. Additionally, culturing in a low oxygen tension produced a similar effect to freshly obtained zygotes on H3K9ac. However, zygote density, whether 1 or 10 zygotes per drop of culture medium, had no significant effect on levels of H3K9ac. Additionally, changing the zygote environment and mode of fertilisation caused changes in chromatin configuration demonstrated by different DNA staining (DAPI) levels. A link is also demonstrated between DNA synthesis and H3K9ac in zygotes, using a DNA synthesis inhibitor.
Conclusions
Results demonstrate that in vitro culture is the main adverse stressor on H3K9ac irrespective of method of fertilisation, and that the impact is exacerbated when suboptimal media are used. Maternal age affects H3K9ac when combined with superovulation methods. While oxygen tension affects epigenetic reprogramming, embryo density does not. Chromatin configuration is affected by different manipulations. A new insight into the relationship between DNA replication and H3k9ac is demonstrated. The usefulness of H3K9ac measurements as a biomarker of stress in the early embryo in ART is confirmed.
Implications
H3K9ac is shown to have a powerful influence on transcription, chromatin conformation, and DNA replication. If ART manipulation can change this, then ART might indicate bigger epigenome aberrations that are critical for embryonic growth and development. While this research programme has contributed novel information that if applied might improve the quality of zygotes by using an optimising culture medium, decreasing the time of culture and using a low oxygen environment in vitro, it also identifies the need for further research in this discipline.
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Valenzuela, Alcaraz Brenda I. "Cardiovascular assessment in fetuses and children conceived by assisted reproductive technologies." Doctoral thesis, Universitat de Barcelona, 2016. http://hdl.handle.net/10803/401805.
Full textAbstract:
BACKGROUND: Approximately, five million children have been born as a result of using assisted reproductive technologies (ART). Although the majority of ART children are born healthy; there are several reports of increased rate of pregnancy complications and worse perinatal outcomes in this population that may contribute to long-term health consequences according to the fetal programming hypothesis. Due to these techniques are relatively new, the effect of ART on later stages of development and adult susceptibility are uncertain. The main hypothesis of this thesis is that fetuses conceived by ART present worse perinatal outcomes together with primary cardiovascular remodeling and dysfunction as compared to those spontaneously conceived (SC), changes that persist postnatally and leads to increased cardiovascular risk in adulthood. METHODS: Cardiovascular morphology and functional assessment was performed in singleton and twin fetuses conceived by ART and spontaneously conceived; together with the presence of adverse perinatal outcomes. Finally, follow-up of these cohorts was made and cardiac and vascular function was assessed in childhood. RESULTS: ART fetuses showed: larger atria, shorter ventricles with lower sphericity index together with thicker myocardial walls. Systolic motion was decreased as measured by M-Mode and tissue Doppler; there were also sings of impaired relaxation, as demonstrated by a longer IRT and decreased deceleration time of E wave. All these changes were independent of the presence of been small for gestational age (SGA) due to these groups showed different cardiac phenotypes. ART children showed persistence of changes in cardiac morphology and function together with vascular remodeling (increased blood pressure and thicker carotid intima media). CONCLUSIONS: Adverse pregnancy outcomes seem to be present in infertile women, regardless of the use of ART. Singleton and twin ART fetuses present cardiovascular remodeling and subclinical dysfunction that persist postnatally in childhood. These changes are independent of the presence of SGA. These findings need to be take into account for further studies regarding higher cardiovascular risks in adulthood in this population.<br>INTRODUCCION: Aproximadamente, 5 millones de niños han nacido en el mundo gracias al uso de las tecnicas de reproduccion asistida (TRA). La mayoría de éstos niños son sanos al nacer; pero diversos estudios mencionan la presencia de peores resultados perinatales en esta población; los cuáles podrían tener consecuencias a largo plazo de acuerdo con la teoría de la programación fetal. Estas técnicas son relativamente nuevas, por lo que sus efectos en la vida adulta aún son desconocidos. La hipótesis principal de ésta tesis es que los fetos concebidos mediante TRA, presentan peores resultados perinatales que aquellos concebidos de manera espontánea (CE), junto con la presencia de cambios cardíacos morfológicos y funcionales que persisten de manera postnatal y que condicionaría un incremento del riesgo cardiovascular en la vida adulta. METODOS: Se llevó a cabo la evaluación cardiovascular morfológica y funcional de fetos únicos y gemelares concebidos por TRA comparados con fetos CE; junto con la presencia de resultados perinatales adversos. Se realiza un seguimiento y evaluación cardiovascular de dichas cohortes hasta la infancia. RESULTADOS: Los fetos TRA presentaron cambios al comparlos con los CE: aurículas más grandes, ventrículos más cortos junto con un menor índice de esfericidad así como paredes engrosadas. presentaron función sistólica disminuída de acuerdo con las mediciones de Doppler tisular y modo-M; también signos de disfunción diastólica demostrado por IRT alargados y disminución del tiempo de deceleración de la onda E. Todos estos cambios fueron independientes de la presencia de fetos pequeños para la edad gestacional (PEG), ya que dichos grupos presentaron fenotipos cardiacos diferentes. En la infancia, los niños TRA mostraron persistencia de dichos cambios cardíacos morfológicos y funcionales subclínicos, junto con remodelado vascular (presion arterial más alta y paredes engrosadas de la intima media de las carótidas). CONCLUSIONES: Las mujeres infértiles presentan resultados perinatales adversos independiente de el método de TRA usado. Los fetos concebidos mediante TRA presentan remodelado cardiovascular el cuál persiste postnatalmente en la infancia. Dichos cambios fueron independientes de la presencia de PEG. Estos hallazgos deben ser tomados en cuentra en futuros estudios del incremento de riesgo cardiovascular en la vida adulta de ésta población.
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Hultling, Claes. "Assisted reproduction technology in men with ejaculatory dysfunction with special reference to spinal cord injury /." Stockholm, 1998. http://diss.kib.ki.se/1998/91-628-2806-1/.
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Mumford, Karen Rose. "The Stress Response, Psychoeducational Interventions and Assisted Reproduction Technology Treatment Outcomes: A Meta-Analytic Review." [Tampa, Fla.] : University of South Florida, 2004. http://purl.fcla.edu/fcla/etd/SFE0000495.
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Wunderlin, Beverly J. "The Regulation of Medically Assisted Procreation in Europe and Related Nations and the Influence of National Identity, Social Cultural, and Demographic Differences." Thesis, University of North Texas, 2002. https://digital.library.unt.edu/ark:/67531/metadc3192/.
Full textAbstract:
This study details the Medically Assisted Procreation regulations in thirty-five nation-states, and explores the influence of national identity, social cultural and demographic differences on these regulations. Detailed data were gathered from ministries of health, offices of prime ministers, embassy staff, and others on regulations for each nation. These data were used to categorize the nations in regard to MAP legislation status and regulatory policy regarding marital or age restrictions; posthumous conception; sperm, ovum, or embryo donation, surrogacy; and policy on handling donors. Possible associations between national identity, social cultural, and demographic data for each nation and their regulations were explained. The thirty-five nations were treated as a population with common geographical and political ties. PRE methods, and eta coefficients were used to assess the associations. Sixteen nations have adopted MAP legislation, eight nations have either alternative regulatory guidelines or partial structures, four nations have legislation pending and possibly some laws, and seven nations are unregulated. Based upon statistical analysis, language group emerges as an important indicator for differences in MAP regulations. For example knowing a nation's language group enabled percent improved prediction of that nation's regulatory handling of embryo donation. The percent GDP spent on health care was found to have a substantial or moderate association with most regulations. The findings of this study indicate that the cultural roots associated with national identity as well as economic circumstances such as health care budgets impact the policy making process responsible for the regulation of MAP in Europe. Among other mediating circumstances, MAP related family law cases brought to the European Court of Human Rights create an accumulation of judge-made law, which help create a common European standard. This study of the European region provides a baseline for further research and a reference for cross cultural comparisons.
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Senaya, Charles M. "Outcome of assisted reproductive technology in women with poor ovarian response undergoing infertility treatment in the reproductive medicine unit of Groote Schuur hospital: a five-year review." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/34032.
Full textAbstract:
Background: Poor response of the ovaries to gonadotropin stimulation is associated with poor outcome following in vitro fertilization. The historical lack of a standard definition for poor ovarian response has resulted in a wide variation in prevalence and outcome measures. More recently, the Bologna criteria has emerged as the standard for identification of poor ovarian responders. There is paucity of literature on poor ovarian response in the African setting. This study was conducted to document the prevalence and the outcome of in vitro fertilization among poor ovarian responders in women undergoing assisted reproduction technology in the public sector of Western Cape Province of South Africa. Method: Retrospective review of data of women who underwent assisted reproduction technology between January 2011 and December 2015 was conducted. The Bologna criteria was used to identify women for inclusion into the study. For the analysis of prevalence and treatment outcomes, only a woman's first cycle at the Groote Schuur Hospital was included, however the occurrence of further cycles was recorded. Main results: A total of 40 women met the criteria for poor ovarian response in this study. The prevalence of poor ovarian response was 3.6%. The mean age among the study population was 37.8years (25 – 42yrs). Cycle cancellation rate due to poor ovarian response was 15.0% and the average number of eggs retrieved was 1.8. Twenty-four (60%) women had at least one embryo transferred. The clinical pregnancy and live birth rates were 10.0% and 5.0% respectively, per cycle initiated. Half of those with failed IVF due to poor ovarian response withdrew from the program. Conclusion: The prevalence of poor ovarian response among women who underwent assisted reproduction at Groote Schuur Hospital was 3.6% which is low compared to 9-24% reported in other studies. The clinical pregnancy and live birth rates were low. Half of the women did not continue with treatment after their first failed IVF cycle.
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Schwarz, Lukas [Verfasser], Oliver G. [Akademischer Betreuer] Schmidt, Oliver G. [Gutachter] Schmidt, and Benjamin [Gutachter] Friedrich. "Magnetic Micromotors in Assisted Reproductive Technology / Lukas Schwarz ; Gutachter: Oliver G. Schmidt, Benjamin Friedrich ; Betreuer: Oliver G. Schmidt." Chemnitz : Technische Universität Chemnitz, 2020. http://d-nb.info/1220943169/34.
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NOTARSTEFANO, VALENTINA. "Development of new molecular tools for the characterization of human Granulosa cells: new implications for the research on human infertility." Doctoral thesis, Università Politecnica delle Marche, 2018. http://hdl.handle.net/11566/252927.
Full textAbstract:
Nella routine della riproduzione assistita, la selezione degli ovociti si basa sulle loro caratteristiche
morfologiche, nonostante la scarsa correlazione tra tali parametri e la competenza dell’ovocita. Pertanto,
la ricerca si sta concentrando sull’identificazione di marker che possano supportare l’attuale metodica di
valutazione, in particolare studiando le cellule della Granulosa (GCs), che svolgono compiti fondamentali
all’interno del microambiente del follicolo: produzione di estradiolo e progesterone, regolazione
dell’avanzamento della meiosi e dell’attività trascrizionale dell’ovocita, produzione di nutrienti essenziali
per l’ovocita, e accumulo di metaboliti secreti. Pertanto, la progressione degli step della follicologenesi
dipende strettamente dalla comunicazione bidirezionale tra ovocita e le cellule somatiche che lo
circondano.
Lo studio delle GCs ha messo in luce molti aspetti circa le funzionalità ovariche, la follicologenesi, e i
meccanismi con cui fattori endogeni ed esogeni possono alterare questi delicati processi.
In questo senso, lo scopo principale del presente PhD è stato quello di caratterizzare le GCs, applicando
per la prima volta la tecnica Fourier Transform Infrared Microspectroscopy (FTIRM), in modo da
sviluppare un nuovo metodo per valutare la qualità degli ovociti umani. Questo potrebbe rappresentare
uno strumento nuovo, affidabile e oggettivo per la valutazione della qualità degli ovociti nella routine
della riproduzione assistita.
Oltre al tema principale, sono state applicate le tecniche FTIRM, Raman Microspectroscopy e qPCR per
studiare i meccanismi di intaccamento del metabolismo, della composizione biochimica e dell’attività
cellulare causati da fattori endogeni ed esogeni, in particolare l’invecchiamento riproduttivo,
l’endometriosi ovarica e inquinanti plastici.
Le informazioni ottenute su queste cellule contribuiscono alla comprensione dei meccanismi di
danneggiamento della follicologenesi, tramite un approccio multidisciplinare che ha visto l’accoppiamento
di analisi spettroscopiche e qPCR. Grazie ai risultati ottenuti, è stato proposto un approccio innovativo
per l’analisi della qualità degli ovociti tramite caratteristiche spettrali delle GCs, suggerendo la possibilità
di un’applicazione dell’FTIRM come strumento diagnostico di facile utilizzo nella routine di riproduzione
assistita.<br>In assisted reproductive routine, oocyte selection is based on its morphological features, which seem not
to be related to its intrinsic competence. Hence, several efforts have been made to identify markers to be
added to the actual evaluation, in particular focusing on the crucial roles of Granulosa cells (GCs) in the
follicular microenvironment: production of estradiol and progesterone, regulation of the meiosis steps and
the transcriptional activity in the oocyte, production of essential nutrients for the oocyte, and
accumulation of secreted metabolites. Hence, the progression through the steps of folliculogenesis heavily
relies upon bi-directional interactions between germ cells and the surrounding somatic cells.
The study of GCs has shown to be determining to highlight particular features of ovarian mechanisms
and folliculogenesis, and also to identify the endogenous and exogenous factors that can impair these
delicate processes.
In this sense, the main aim of the PhD project was to characterize GCs, applying for the first time Fourier
Transform Infrared Microspectroscopy (FTIRM) to develop a method for evaluating the quality of human
oocytes. This could represent a new, reliable and objective tool for oocyte quality assessment in assisted
reproduction routine.
Besides this main topic, the impairment induced by endogenous and exogenous factors on the biochemical
composition, metabolism and cellular activity of GCs was also investigated by FTIRM, Raman
Microspectroscopy and qPCR, shedding new light on the mechanisms governing folliculogenesis. In
particular, the research was focused on the impairment determined by reproductive aging, ovarian
endometriosis, and plastic pollutants.
The information obtained on GCs contribute to the understanding of the mechanisms of impairment of
folliculogenesis, by a multidisciplinary approach made of spectroscopic analysis and qPCR. Thanks to the
results, an innovative approach to evaluate oocyte quality by spectral features of GCs was proposed,
suggesting the possibility to apply FTIRM as a clinical feasible diagnostic tool in assisted reproduction
routine.
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Nuojua-Huttunen, S. (Sinikka). "Intrauterine insemination (IUI) treatment in subfertility." Doctoral thesis, University of Oulu, 1999. http://urn.fi/urn:isbn:9514251717.
Full textAbstract:
Abstract
The effectiveness of intrauterine insemination (IUI) combined with controlled ovarian hyperstimulation (COH) in the treatment of subfertility was investigated in the present study. For this purpose the prognostic factors associated with success of clomiphene citrate (CC)/human menopausal gonadotrophin (HMG)/IUI were identified in 811 treatment cycles. Furthermore, a long gonadotrophin-releasing hormone agonist (GnRHa)/HMG stimulation protocol was compared with a standard CC/HMG protocol. In addition, the usefulness of alternative insemination techniques including fallopian tube sperm perfusion (FSP) and intrafollicular insemination (IFI) was investigated. Finally, the obstetric and perinatal outcome of pregnancies after COH/IUI was examined and compared with those of matched spontaneous and in vitro fertilization(IVF) pregnancies.
Female age, duration of infertility, aetiology of infertility, number of large preovulatory follicles and number of the treatment cycle were predictive as regards pregnancy after CC/HMG/IUI. The highest pregnancy rate (PR) was obtained in women of < 40 years of age with infertility duration ≤ 6 years, who did not suffer from endometriosis. A multifollicular ovarian response to CC/HMG resulted in better treatment success than a monofollicular response, indicating the necessity of COH combined with IUI. A significantly higher PR was achieved in the first treatment cycles compared with the others, and 97% of the pregnancies were obtained in the first four treatment cycles.
The PR per cycle did not differ significantly between a long GnRHa/HMG and a standard CC/HMG protocol, but the average medication expense of GnRHa/HMG stimulation was four times the cost of CC/HMG stimulation. Therefore, the routine use of a long GnRHa/HMG protocol in IUI treatment remains questionable.
The FSP procedure was easy to perform by using a paediatric Foley catheter. The success rate in couples with either FSP or standard IUI did not differ significantly, although there was a trend towards a lower PR in the FSP group. The FSP technique should not replace the simpler and less time-consuming IUI technique in routine use. The IFI technique was also simple to perform and convenient for patients. However, only one normal singleton intrauterine pregnancy resulted in 50 IFI-treated women, indicating that IFI is inefficacious for treating subfertility.
The IUI parturients differed from average Finnish parturients in respect to higher maternal age, more frequent primiparity and a higher incidence of multiple pregnancies. The use of antenatal care services was significantly lower in IUI singleton pregnancies compared with IVF singletons, although there were no more complications in IVF pregnancies. The hospitalization and Caesarean section rates were generally high in all pregnancies. The mean birthweight of IUI singletons was significantly lower than that in spontaneous pregnancies, but comparable to that in IVF pregnancies. However, the incidence of preterm birth, low birth weight and other variables describing the outcome of infants were similar in IUI, IVF and spontaneous pregnancies. In summary, the IUI procedure itself does not seem to affect adversely the obstetric and perinatal outcome of pregnancy, and patient characteristics and multiplicity may be more important in this respect.
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Couture, Vincent. "Les vases communicants : une ethnographie des services reproductifs transfrontaliers au Canada." Thèse, Université de Sherbrooke, 2018. http://hdl.handle.net/11143/11862.
Full textAbstract:
Les services reproductifs transfrontaliers (SRT) réfèrent au déplacement d'une juridiction à une autre, de personnes ou de matériel reproductif dans le cadre d'un projet de procréation assistée (PA). Ce phénomène a été observé dans de nombreux pays, mais le système de PA mondialisé canadien, ou reproscape, demeure sous-étudié. Ce manque de connaissances nuit au développement normatif en matière de PA. En adoptant un cadre conceptuel issu de l'anthropologie médicale, l'objectif général de cette thèse était de décrire et comprendre le reproscape canadien. Pour alimenter la réflexion éthique et juridique et la prestation des services de PA, nous avons réalisé une enquête ethnographique clinique multisite combinant : (1) une revue de la littérature, (2) l'observation participante et non participante de deux cliniques de fertilité (Québec et Ontario), d'une agence d'importation de gamètes et d'une dizaine de congrès scientifiques, ainsi que (3) des entrevues semi-dirigées avec 45 actrices et acteurs des SRT : personnes utilisatrices, personnel médical et intermédiaires. Les données ont fait l'objet d'une analyse qualitative inductive, assistée du logiciel NVivo 11.
Trois dimensions émergent de nos résultats. (1) Le Canada se caractérise par une mosaïque de lois et de règlements locaux, fédéraux et provinciaux qui influencent de façon paradoxale les SRT. L'obligation de don altruiste, établie par la Loi sur la procréation assistée (LPA), joue un rôle prédominant sur le reproscape canadien. (2) Au niveau de l'expérience des SRT, la simplicité de certains SRT intégrés à la pratique clinique, comme l'importation de sperme ou d'ovocytes, contraste avec la complexité des voyages vers l'étranger auxquels les personnes utilisatrices se sentent souvent contraintes. (3) Interrogées sur leurs perspectives éthiques, quatre positions principales ressortent des entrevues: (a) le respect de leur autonomie reproductive, (b) les risques individuels et (c) sociaux des SRT, dont celui d'exploitation des gestatrices et des donneuses d'ovules, ainsi que (d) les incohérences de la LPA quant à sa capacité d'atténuer ces risques. En conclusion, le reproscape canadien se caractérise, entre autres, par une situation de " sous-traitance reproductive " : une reconnaissance institutionnelle des SRT, combinée à une délocalisation des risques moraux et médicaux hors des frontières nationales. Les conclusions de notre étude mettent en évidence le caractère inextricable du local et du global en PA et comment le reproscape mondial fonctionne par vases communicants.<br>Abstract : Cross-border reproductive care (CBRC) refers to the movement from one jurisdiction to another of persons or reproductive material as part of assisted reproductive technology (ART) treatment. This phenomenon has been observed in many countries, but the Canadian globalized ART system (or "reproscape") remains understudied empirically. This lack of data undermines the normative development in terms of ART. The aim of this dissertation is to describe and understand the Canadian reproscape in order to support ethical and legal reflection. To achieve this goal, we conducted a multi-site clinical ethnography combining (1) literature reviews, (2) participant and non-participant observation in two fertility clinics (Quebec and Ontario), a gamete importation and distribution agency and a dozen scientific congresses, (3) as well as semi-directed interviews with 45 actors of CBRC: users, medical professionals and intermediaries. The data were analyzed by inductive qualitative analysis assisted by NVivo 11 software.
Three dimensions emerge from our results. (1) Regarding the legal and clinical contexts of ART, Canada is characterized by a local mosaic of laws and regulations that paradoxically influence CBRC. The altruistic obligation established by the Assisted Human Reproduction Act (AHRA) plays a predominant role on the reproscape. (2) In terms of the experience of the main actors, the simplicity of CBRC integrated to the clinic, such as the import of semen or oocytes, contrasts with the complexity of journeys abroad for which users often feel constrained. (3) When asked about their ethical perspectives, the actors mentioned four main positions: (a) the respect for their reproductive autonomy, (b) the individual and (c) social risks of CBRC, including the exploitation of egg donors as well as gestational surrogates, and (d) AHRA inconsistencies in its ability to mitigate these risks.
Our conclusion is that the Canadian reproscape is characterized, inter alia, by a situation of "reproductive outsourcing." This concept is characterized by an institutional recognition of CBRC combined with a relocation of moral and medical risks outside national borders. The results of our study underline the inextricable local and global nature of ART and how CBRC works as communicating vessels.
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Uner, Ozge. "A Study On Social And Affective Dimensions Of The Use Of Assisted Reproduction Technology (art) By Women In Turkey." Master's thesis, METU, 2004. http://etd.lib.metu.edu.tr/upload/12605229/index.pdf.
Full textAbstract:
This thesis aims to discuss the concept of Assisted Reproduction Technology and its
social and affective impacts. Women will be at the center of this research as it has been
thought that emotional stressors are mostly effective on them. In the present work, an
investigation will be carried out among women who have used assisted reproduction
technology methods and women who are able to reproduce and conceive &ldquo<br>naturally&rdquo<br>.
The comparison of these two groups will illuminate problematical aspects of assisted
reproduction technology. The research will be based on two sets of questionnaires
designed for each group of women. In this study, both qualitative and quantitative data
were used. These analyses will not only lead us to compare infertile and fertile
women&rsquo<br>s responses and evaluate the consequences of emergent assisted reproduction
technology but also to assess its social and emotional impacts.
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Dedrick, Elizabeth A. "The politics of being an egg "donor" and shifting notions of reproductive freedom." [Tampa, Fla.] : University of South Florida, 2004. http://purl.fcla.edu/fcla/etd/SFE0000286.
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Smith, Malcolm. "Regulating IVF and pre-implantation tissue-typing for the creation of "saviour siblings" : a harm analysis." Thesis, Queensland University of Technology, 2010. https://eprints.qut.edu.au/35798/1/Malcolm_Smith_Thesis.pdf.
Full textAbstract:
Scientific discoveries, developments in medicine and health issues are the constant focus of media attention and the principles surrounding the creation of so called ‘saviour siblings’ are of no exception. The development in the field of reproductive techniques has provided the ability to genetically analyse embryos created in the laboratory to enable parents to implant selected embryos to create a tissue-matched child who may be able to cure an existing sick child. The research undertaken in this thesis examines the regulatory frameworks overseeing the delivery of assisted reproductive technologies (ART) in Australia and the United Kingdom and considers how those frameworks impact on the accessibility of in vitro fertilisation (IVF) procedures for the creation of ‘saviour siblings’. In some jurisdictions, the accessibility of such techniques is limited by statutory requirements. The limitations and restrictions imposed by the state in relation to the technology are analysed in order to establish whether such restrictions are justified. The analysis is conducted on the basis of a harm framework. The framework seeks to establish whether those affected by the use of the technology (including the child who will be created) are harmed. In order to undertake such evaluation, the concept of harm is considered under the scope of John Stuart Mill’s liberal theory and the Harm Principle is used as a normative tool to judge whether the level of harm that may result, justifies state intervention or restriction with the reproductive decision-making of parents in this context. The harm analysis conducted in this thesis seeks to determine an appropriate regulatory response in relation to the use of pre-implantation tissue-typing for the creation of ‘saviour siblings’. The proposals outlined in the last part of this thesis seek to address the concern that harm may result from the practice of pre-implantation tissue-typing. The current regulatory frameworks in place are also analysed on the basis of the harm framework established in this thesis. The material referred to in this thesis reflects the law and policy in place in Australia and the UK at the time the thesis was submitted for examination (December 2009).
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Kirsch, Juliane Katharina [Verfasser]. "Bedeutung von AMH in Follikelflüssigkeit und Serum bei Behandlung von Patientinnen im Rahmen eines ART-Programmes (Assisted Reproductive Technology) / Juliane Katharina Kirsch." Kiel : Universitätsbibliothek Kiel, 2018. http://d-nb.info/1161729496/34.
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Santoso, Benedicta. "The effect of sperm apoptosis, Reactive Oxygen Species (ROS) and semen sample handling on sperm parameters and Assisted Reproductive Technology (ART) outcomes." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2020. https://ro.ecu.edu.au/theses/2373.
Full textAbstract:
Overall, this doctoral study aimed to contribute to the existing knowledge and clinical practice regarding male infertility, especially in relation to the potential sources and clinical impact of sperm apoptosis and reactive oxygen species (ROS) in the context of assisted reproductive technology (ART).
This thesis encompasses three independent studies, each of which addresses a single aim related to different aspects of male infertility and ART practices.
Study 1 examined the relationship between sperm apoptosis and ROS levels and ART outcomes. On the day of oocyte retrieval, the levels of sperm apoptosis (measured using Annexin V staining) and intracellular ROS (measured using dihydroethidium staining) were measured in neat and processed semen samples from a total of 170 male patients whose partners were undergoing in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) treatment cycles. In general, higher levels of apoptosis and ROS were associated with lower sperm motility, sperm count and advanced paternal age. No correlation was observed between sperm apoptosis and fertilisation rate, blastulation rate, day 5 embryo quality (D5EQ) and clinical pregnancy. Similarly, there was no correlation between sperm ROS levels and fertilisation rate and clinical pregnancy. However, higher levels of ROS might be associated with poorer early stages of embryonic development, as indicated by blastulation rate and D5EQ. Together, the findings suggest that although sperm apoptosis and ROS had an adverse effect on sperm parameters, the effect on clinical outcomes was minimal.
Study 2 compared the efficacy of three sperm preparation methods, namely density gradient centrifugation (DGC), the swim-up method and SeaforiaTM, in reducing the levels of sperm apoptosis and ROS. The measurement of sperm apoptosis and ROS levels were performed on a total of 17 pooled semen samples before and after sperm preparation. The main findings suggest that all three methods effectively reduced sperm apoptosis levels in the neat samples. However, only swim-up and SeaforiaTM were effective in reducing the ROS levels. Compared with DGC and swim-up, SeaforiaTM also produced samples with a higher total yield.
Study 3 investigated the effects of different time intervals during ART sperm preparation on clinical outcomes. Three time intervals including pre-wash interval (time between ejaculation and sperm preparation), post-wash interval (time between sperm preparation and insemination/sperm injection) and total interval (time between ejaculation and insemination/sperm injection) were calculated and retrospectively analysed from a total of 8,079 IVF/ICSI cycles. The results showed that prolonged pre- and post-wash and total intervals had an adverse effect on sperm motility and clinical outcomes including fertilisation rate and pregnancy outcomes. Intracellular ROS production during prolonged incubation was considered to be the most likely facilitator of this observed effect.
In summary, this thesis demonstrates that although their effect on ART outcomes were at low levels, higher levels of sperm apoptosis and ROS were associated with poorer sperm parameters, and suggestive of, a lower chance of natural conception. The cumulative findings of this thesis are indicative of the central role of ROS levels in sperm physiological functions and suggest that minimising intracellular ROS production through sperm preparation techniques and time optimisation may be beneficial to improving ART outcomes
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Burger, Riana. "Evaluation of spermatozoa DNA tests for an assisted reproductive techniques (ART) program : correlation with semen parameters and ART outcome." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/80343.
Full textAbstract:
Thesis (MScMedSc)--Stellenbosch University, 2013.<br>ENGLISH ABSTRACT: CHAPTER 1
A review of the application of traditional semen parameters for the investigation and diagnosis of male infertility and the role of predictive values in assisted reproductive techniques (ART) is presented. The importance of sperm morphology, with special emphasis on sperm morphology evaluation, is discussed. Also presented is an overview of the physiology of sperm DNA, the process of spermatogenesis, as well as the contribution of the spermatozoon to the embryo. The different causes of sperm DNA damage and techniques to determine DNA damage in spermatozoa are described. A survey is presented of the correlation of sperm DNA with sperm morphology.
CHAPTER 2
All the materials and methods applicable to this study are described. Sperm morphology assessment and two different sperm DNA tests, the chromomycin A3 (CMA3) staining test and the terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate (dUTP) nick-end labelling (TUNEL) assay, are discussed in detail.
CHAPTER 3 Results obtained in this study are presented. Results include the prevalence of abnormal sperm DNA and association with sperm morphology, specifically in the p-pattern and g-pattern morphology groups. Further results include the correlation of sperm morphology and sperm DNA with fertilization in vitro, embryo quality and pregnancy outcome. The percentage CMA3 positive spermatozoa (abnormal DNA) and percentage TUNEL positive spermatozoa (abnormal DNA) had a significant negative association with normal sperm morphology. P-pattern and g-pattern morphology groups differed significantly from each other for both CMA3 and TUNEL. A significant positive association between CMA3 and TUNEL was observed.
No association between the percentage normal sperm morphology, percentage CMA3 positive spermatozoa and percentage TUNEL positive spermatozoa and IUI pregnancy outcome was observed. A significant negative association between the percentage TUNEL positive spermatozoa and IVF/ICSI pregnancy outcome was established. The percentage CMA3 positive spermatozoa had a significant positive (unexpected) association with IVF/ICSI pregnancy outcome. There was no association between the three variables and IVF/ICSI fertilization rates. A significant positive association between the percentage normal sperm morphology and IVF/ICSI embryo quality was found. There was a significant positive association between the percentage CMA3 positive spermatozoa and IVF/ICSI embryo quality (unexpected). The percentage TUNEL positive spermatozoa and IVF/ICSI embryo quality was negatively associated.
CHAPTER 4
Interpretation of the results and future perspectives are discussed. The CMA3 staining test and TUNEL assay has a limited ability to distinguish between the p-pattern and g-pattern morphology groups. P-pattern spermatozoa are more likely to possess poor chromatin packaging and show increased levels of DNA fragmentation, but some p-pattern patients also may have normal DNA and g-pattern patients abnormal DNA. It is recommended that a sperm DNA test should be implemented routinely in andrology laboratories for the clinical diagnosis of sperm DNA damage in patients.<br>AFRIKAANSE OPSOMMING: HOOFSTUK 1
'n Samevatting wat handel oor die toepassing van tradisionele semen parameters vir die evaluasie en diagnose van manlike infertiliteit, asook die rol van voorspellingswaardes in kunsmatige voortplantingstegnieke word voorgelê. Die belangrikheid van sperm morfologie, met die klem op sperm morfologie evaluering, word ook bespreek. 'n Oorsig van sperm DNS fisiologie, die proses van spermatogenese, sowel as die sperm se bydrae tot die embrio word hier aangebied. Die verskillende oorsake van sperm DNS skade en die tegnieke om sperm DNS skade vas te stel, asook die die korrelasie tussen sperm DNS en sperm morfologie word ook bespreek.
HOOFSTUK 2
Alle materiale en metodes wat van toepassing is op hierdie studie word beskryf. Sperm morfologie evaluering en twee verskillende sperm DNS toetse, die chromomycin A3 (CMA3) kleuringstoets en die “terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate (dUTP) nick-end labelling (TUNEL)" toets, word ook in meer besonderhede aangebied.
HOOFSTUK 3 Resultate wat verkry is tydens hierdie studie word hier uiteengesit. Resultate behels die voorkomsyfer van abnormale DNS en die assosiasie met sperm morfologie, spesifiek in die p-patroon en g-patroon. Verdere resultate sluit die korrelasie van sperm morfologie en sperm DNS met bevrugting in vitro, embriokwaliteit en swangerskap uitkomste in. Die persentasie CMA3 positiewe sperme (abnormale DNS) en persentasie TUNEL positiewe sperme (abnormale DNS) het 'n betekenisvolle negatiewe assosiasie met normale sperm morfologie getoon. P-patroon en g-patroon morfologie groepe het betekenisvol van mekaar verskil vir beide CMA3 en TUNEL. 'n Betekenisvolle positiewe assosiasie is tussen CMA3 en TUNEL waargeneem. Geen assosiasie is tussen die persentasie normale sperm morfologie, persentasie CMA3 positiewe sperme en persentasie TUNEL positiewe sperme en IUI swangerskap uitkomste waargeneem nie. 'n Betekenisvolle negatiewe assosiasie is tussen die persentasie TUNEL positiewe sperme en IVB/ICSI swangerskap uitkomste vasgestel. Die persentasie CMA3 positiewe sperme het 'n betekenisvolle positiewe (onverwags) assosiasie met IVB/ICSI swangeskap uitkomste opgewys. Daar was geen assosiasie tussen die drie veranderlikes en IVB/ICSI bevrugting nie. 'n Betekenisvolle positiewe assosiasie is tussen die persentasie normale sperm morfologie en IVB/ICSI embryo kwaliteit waargeneem. Daar was 'n betekenisvolle positiewe assosiasie tussen die persentasie CMA3 positiewe sperme en IVB/ICSI embrio kwaliteit (onverwags). Die persentasie TUNEL positiewe sperme het 'n negatiewe assosiasie met IVB/ICSI embrio kwaliteit getoon.
HOOFSTUK 4
Interpretasie van die resultate en toekomstige vooruitsigte is bespreek. Die CMA3 kleuringstoets en TUNEL toets het 'n beperkte vermoë om tussen die p-patroon en g-patroon morfologie groepe te onderskei. P-patroon spermatozoa sal heel waarskynlik oor swakker chromatien verpakking en meer DNS fragmentasie beskik. Sommige p-patroon pasiënte mag egter normale DNS toon, terwyl g-patroon pasiënte abnormale DNS het. Die implementering van 'n sperm DNS toets in andrologie laboratoriums, vir die kliniese diagnose van sperm DNS skade in pasiënte, word aanbeveel.